Provider Demographics
NPI:1841915170
Name:SCOTT, STEPHEN (MA, LLPC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2878 W LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9641
Mailing Address - Country:US
Mailing Address - Phone:231-668-4426
Mailing Address - Fax:
Practice Address - Street 1:928 S GARFIELD AVE STE 3
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2403
Practice Address - Country:US
Practice Address - Phone:231-668-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022526101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor