Provider Demographics
NPI:1881366979
Name:SCOTT, ROBERT CARL (MS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CARL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 CAPE LISBURNE LOOP
Mailing Address - Street 2:SPC 568
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504
Mailing Address - Country:US
Mailing Address - Phone:907-830-5472
Mailing Address - Fax:
Practice Address - Street 1:QUYANA CLUB HOUSE
Practice Address - Street 2:225 EAGLE STREET
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-729-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician