Provider Demographics
NPI:1821804022
Name:SCOFIELD, STEVEN RUSSELL
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RUSSELL
Last Name:SCOFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 VAN AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-2641
Mailing Address - Country:US
Mailing Address - Phone:317-604-0083
Mailing Address - Fax:
Practice Address - Street 1:1121 E STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1772
Practice Address - Country:US
Practice Address - Phone:317-392-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1259253103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool