Healthcare Provider Details

I. General information

NPI: 1356617807
Provider Name (Legal Business Name): SCOTT COMMUNITY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W 6TH ST STE 208
MOSCOW ID
83843-2387
US

IV. Provider business mailing address

507 OREGON ST
DEARY ID
83823
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-3504
  • Fax: 877-935-2107
Mailing address:
  • Phone: 208-877-1444
  • Fax: 208-877-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MELANIE J SCOTT
Title or Position: OWNER
Credential: LSW-I
Phone: 208-882-3504