Healthcare Provider Details

I. General information

NPI: 1568527646
Provider Name (Legal Business Name): SCOTT WHITNEY ABBOTT M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S DORA ST
UKIAH CA
95482-6340
US

IV. Provider business mailing address

1120 S DORA ST
UKIAH CA
95482-6340
US

V. Phone/Fax

Practice location:
  • Phone: 707-472-2326
  • Fax: 707-463-6868
Mailing address:
  • Phone: 707-472-2326
  • Fax: 707-463-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number66413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: