Provider Demographics
NPI:1669876827
Name:SOEDER, SCOTT ALLAN (EDS, LPCC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLAN
Last Name:SOEDER
Suffix:
Gender:M
Credentials:EDS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 FENWICK RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4427
Mailing Address - Country:US
Mailing Address - Phone:330-441-1128
Mailing Address - Fax:
Practice Address - Street 1:8351 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5749
Practice Address - Country:US
Practice Address - Phone:216-839-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871101Medicaid