Healthcare Provider Details

I. General information

NPI: 1093250623
Provider Name (Legal Business Name): IFE SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 E 13TH AVE
ANCHORAGE AK
99501-4739
US

IV. Provider business mailing address

230 W 14TH AVE APT 101
ANCHORAGE AK
99501-5130
US

V. Phone/Fax

Practice location:
  • Phone: 907-201-7870
  • Fax:
Mailing address:
  • Phone: 917-891-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1044958
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: