Provider Demographics
NPI:1750551388
Name:CODON, SCOTT M (LPC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:CODON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 BAHLER AVE
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578
Mailing Address - Country:US
Mailing Address - Phone:281-489-1290
Mailing Address - Fax:281-489-8806
Practice Address - Street 1:3926 BAHLER AVE
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578
Practice Address - Country:US
Practice Address - Phone:281-489-1290
Practice Address - Fax:281-489-8806
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16107101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor