Healthcare Provider Details

I. General information

NPI: 1558923730
Provider Name (Legal Business Name): SCOTT CRAIG NICLOY PSYD,, ABHC, ADM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 E 20TH AVE
ANCHORAGE AK
99508-3416
US

IV. Provider business mailing address

3600 E 20TH AVE
ANCHORAGE AK
99508-3416
US

V. Phone/Fax

Practice location:
  • Phone: 907-743-8733
  • Fax:
Mailing address:
  • Phone: 907-743-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: