Healthcare Provider Details

I. General information

NPI: 1710389341
Provider Name (Legal Business Name): JILL SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LAKEVIEW DR STE 2/3
SEBRING FL
33870-3185
US

IV. Provider business mailing address

2100 LAKEVIEW DR STE 2/3
SEBRING FL
33870-3185
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-3388
  • Fax:
Mailing address:
  • Phone: 863-382-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberIMH 12309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: