Provider Demographics
NPI:1811161615
Name:SCOTT, CHAD SAMUEL (PHD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:SAMUEL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:BOX 1188
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-1188
Mailing Address - Country:US
Mailing Address - Phone:218-741-4714
Mailing Address - Fax:218-749-3806
Practice Address - Street 1:3203 3RD AVE W
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2406
Practice Address - Country:US
Practice Address - Phone:218-263-9237
Practice Address - Fax:218-262-3150
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional