Provider Demographics
NPI:1912533209
Name:SCOTT, SUZANNE L (LPC, MACC, NBCT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPC, MACC, NBCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-4445
Mailing Address - Country:US
Mailing Address - Phone:307-321-8723
Mailing Address - Fax:
Practice Address - Street 1:1227 WEAVER ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-4445
Practice Address - Country:US
Practice Address - Phone:307-321-8723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY101YS0200X
WYLPC-1190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLPC-1190OtherWYOMING MENTAL HEALTH LICENSING BOARD