Provider Demographics
NPI:1982625471
Name:ANDERSON, SCOTT E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:ANDERSON
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:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-0717
Mailing Address - Country:US
Mailing Address - Phone:865-805-9327
Mailing Address - Fax:865-379-9663
Practice Address - Street 1:1120 TOPSIDE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-5502
Practice Address - Country:US
Practice Address - Phone:865-805-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001394103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3683222Medicaid
TN082412Medicare UPIN
TN4076528Medicare UPIN
TN55373260Medicare UPIN
TN3683225Medicare ID - Type Unspecified
SD264367Medicare UPIN
TN2019981Medicare UPIN
TN3683222Medicaid
TN7804085Medicare UPIN