Provider Demographics
NPI:1558903526
Name:SCOTT, JUSTINA HAYES (MA, QMHP)
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:HAYES
Last Name:SCOTT
Suffix:
Gender:
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1146
Mailing Address - Country:US
Mailing Address - Phone:971-271-2154
Mailing Address - Fax:
Practice Address - Street 1:13440 SE 169TH AVE APT 103
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97015-8743
Practice Address - Country:US
Practice Address - Phone:865-363-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health