Provider Demographics
NPI:1639191117
Name:HUNTER, SCOT MONTGOMERY (MA, LP)
Entity type:Individual
Prefix:
First Name:SCOT
Middle Name:MONTGOMERY
Last Name:HUNTER
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-4993
Mailing Address - Fax:651-379-1772
Practice Address - Street 1:1900 SILVER LAKE RD NW
Practice Address - Street 2:SUITE 115
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-1786
Practice Address - Country:US
Practice Address - Phone:651-628-4993
Practice Address - Fax:651-379-1772
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN683753100Medicaid