Healthcare Provider Details

I. General information

NPI: 1306914387
Provider Name (Legal Business Name): SCOTT ALLEN COUPER MTBC, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/21/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NIGHTINGALE RD
EDWARDS CA
93523
US

IV. Provider business mailing address

30 NIGHTINGALE RD.
EDWARDS CA
93523
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-5925
  • Fax:
Mailing address:
  • Phone: 661-277-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: