Healthcare Provider Details

I. General information

NPI: 1427738947
Provider Name (Legal Business Name): SCOTT MCQUEEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 746877
ATLANTA GA
30374-6877
US

IV. Provider business mailing address

PO BOX 115
FERNANDINA BEACH FL
32035-0115
US

V. Phone/Fax

Practice location:
  • Phone: 323-676-7425
  • Fax:
Mailing address:
  • Phone: 925-984-2326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC20712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: