Provider Demographics
NPI:1841023637
Name:EMEOLA, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:EMEOLA
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:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:KECHI
Mailing Address - State:KS
Mailing Address - Zip Code:67067-0394
Mailing Address - Country:US
Mailing Address - Phone:316-253-0773
Mailing Address - Fax:
Practice Address - Street 1:6700 W CENTRAL AVE STE 106
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6302
Practice Address - Country:US
Practice Address - Phone:316-945-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03634-T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist