MEDICARE: SCOTT GORNTO MDIV, LMFT, CST

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	103T00000X	Psychologist	5152	TX
2	106H00000X	Marriage & Family Therapist	5152	TX

General Provider Information

NPI Number	:	1447747209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT GORNTO MDIV, LMFT, CST

Provider Business Mailing Address
First Line	:	6101 CHAPEL HILL BLVD STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8448
Country	:	US
Telephone Number	:	469-396-7680
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 CHAPEL HILL BLVD STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8448
Country	:	US
Telephone Number	:	972-312-8893
Fax Number	:

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

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	04/17/2018

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Directions to “ SCOTT GORNTO MDIV, LMFT, CST” Practice Location

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