Provider Demographics
NPI:1669713558
Name:SCOTT, MINA
Entity type:Individual
Prefix:MRS
First Name:MINA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MINA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3201 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2700
Mailing Address - Country:US
Mailing Address - Phone:918-813-8402
Mailing Address - Fax:918-286-7903
Practice Address - Street 1:3201 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2700
Practice Address - Country:US
Practice Address - Phone:918-813-8402
Practice Address - Fax:918-286-7903
Is Sole Proprietor?:No
Enumeration Date:2013-03-03
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor