Healthcare Provider Details

I. General information

NPI: 1851709935
Provider Name (Legal Business Name): SCOTT MCKEAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LINCOLN AVE STE 108
NAPA CA
94558-4900
US

IV. Provider business mailing address

1100 LINCOLN AVE STE 108
NAPA CA
94558-4900
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-3719
  • Fax: 707-255-3715
Mailing address:
  • Phone: 707-255-3719
  • Fax: 707-255-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number71811
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number71811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: