MEDICARE: MS. BEVERLY JEAN SCOTT MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MFC32468	CA

General Provider Information

NPI Number	:	1023151289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY JEAN SCOTT MFT

Provider Business Mailing Address
First Line	:	2557 VIA CARRILLO
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-2720
Country	:	US
Telephone Number	:	310-544-0166
Fax Number	:	310-544-4152

Provider Business Practice Location Address
First Line	:	326 S PACIFIC COAST HWY
Second Line	:	SUITE 201
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3737
Country	:	US
Telephone Number	:	310-544-0166
Fax Number	:	310-544-4152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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