Provider Demographics
NPI:1649941444
Name:SCOTT, DEMETRIUS THOMAS (LPC, BCBAI)
Entity type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:THOMAS
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LPC, BCBAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 CHESTNUT BND
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6681
Mailing Address - Country:US
Mailing Address - Phone:713-470-7117
Mailing Address - Fax:
Practice Address - Street 1:3910 CHESTNUT BND
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6681
Practice Address - Country:US
Practice Address - Phone:713-470-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional