Provider Demographics
NPI:1932361995
Name:SCOTT, KERRY J (LPC, LAC)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 MOSSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3219
Mailing Address - Country:US
Mailing Address - Phone:318-651-9363
Mailing Address - Fax:318-651-9251
Practice Address - Street 1:2911 CAMERON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3713
Practice Address - Country:US
Practice Address - Phone:318-651-9363
Practice Address - Fax:318-651-9251
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional