Healthcare Provider Details

I. General information

NPI: 1982908505
Provider Name (Legal Business Name): AUTUMN NICOLE SCOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323A E PALMDALE BLVD
PALMDALE CA
93550-4957
US

IV. Provider business mailing address

3025 ONTARIO CT
ROSAMOND CA
93560-7602
US

V. Phone/Fax

Practice location:
  • Phone: 213-259-4184
  • Fax:
Mailing address:
  • Phone: 310-748-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27925
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number64414
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number64414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: