Provider Demographics
NPI:1467265470
Name:FOVAL, SCOTT BOYCE (LADC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:BOYCE
Last Name:FOVAL
Suffix:
Gender:M
Credentials:LADC
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Mailing Address - Street 1:2112 BROADWAY ST NE
Mailing Address - Street 2:STE 225 #279
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-3081
Mailing Address - Country:US
Mailing Address - Phone:561-240-5964
Mailing Address - Fax:
Practice Address - Street 1:5353 WAYZATA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1338
Practice Address - Country:US
Practice Address - Phone:952-222-8383
Practice Address - Fax:952-400-5874
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN306716101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)