MEDICARE: MR. GERALD WAYNE SCOTT B.A.

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	101Y00000X	Counselor
2	101Y00000X	Counselor		OK

General Provider Information

NPI Number	:	1023268000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD WAYNE SCOTT B.A.

Provider Business Mailing Address
First Line	:	2200 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5800
Country	:	US
Telephone Number	:	405-528-1748
Fax Number	:	405-528-1802

Provider Business Practice Location Address
First Line	:	2200 N CLASSEN BLVD STE E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5800
Country	:	US
Telephone Number	:	405-528-1748
Fax Number	:	405-528-1802

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

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	05/04/2016

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