Provider Demographics
NPI:1932264165
Name:MACHLUS, SCOT D (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:D
Last Name:MACHLUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13939 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7116
Mailing Address - Country:US
Mailing Address - Phone:727-862-7171
Mailing Address - Fax:727-372-5035
Practice Address - Street 1:13939 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7116
Practice Address - Country:US
Practice Address - Phone:727-862-7171
Practice Address - Fax:727-372-5035
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4321103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist