Provider Demographics
NPI:1750734505
Name:SCOTT, CAROL (MED, LPC-S)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 100TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-4039
Mailing Address - Country:US
Mailing Address - Phone:806-789-8641
Mailing Address - Fax:
Practice Address - Street 1:3403 73RD ST
Practice Address - Street 2:#16
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1101
Practice Address - Country:US
Practice Address - Phone:806-686-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional