Provider Demographics
NPI:1831554583
Name:SCOTT, KHALID BINWALID (LCSW, CADC)
Entity type:Individual
Prefix:MR
First Name:KHALID
Middle Name:BINWALID
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16926 MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2675
Mailing Address - Country:US
Mailing Address - Phone:312-437-2688
Mailing Address - Fax:312-569-8986
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:HUD-VASH 8 SOUTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-8281
Practice Address - Fax:312-569-8986
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0177531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.017753OtherLCSW
IL30483OtherCADC