Provider Demographics
NPI:1780087551
Name:SCOTT, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37100 CHERRY HILL RD
Mailing Address - Street 2:APARTMENT 101
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3422
Mailing Address - Country:US
Mailing Address - Phone:734-334-8650
Mailing Address - Fax:734-742-0608
Practice Address - Street 1:8623 N WAYNE RD
Practice Address - Street 2:SUITE 325
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1137
Practice Address - Country:US
Practice Address - Phone:734-427-1144
Practice Address - Fax:734-742-0608
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health