Provider Demographics
NPI:1700886306
Name:SCOFIELD, MARK ALLEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:SCOFIELD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 FORESIGHT CIRCLE
Mailing Address - Street 2:#2
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505
Mailing Address - Country:US
Mailing Address - Phone:970-254-8600
Mailing Address - Fax:970-254-8603
Practice Address - Street 1:2516 FORESIGHT CIR
Practice Address - Street 2:#2
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1096
Practice Address - Country:US
Practice Address - Phone:970-254-8600
Practice Address - Fax:970-254-8603
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9919451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72777249Medicaid
COC805304Medicare PIN