Provider Demographics
NPI:1265595508
Name:SCOTT, AMY L W (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L W
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SAND CREEK RD STE 215
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2220
Mailing Address - Country:US
Mailing Address - Phone:925-325-1728
Mailing Address - Fax:925-464-1142
Practice Address - Street 1:191 SAND CREEK RD STE 215
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2220
Practice Address - Country:US
Practice Address - Phone:925-325-1728
Practice Address - Fax:925-464-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist