Healthcare Provider Details

I. General information

NPI: 1356644769
Provider Name (Legal Business Name): SCOTT COMMUNITY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
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

PO BOX 307
DEARY ID
83823-0307
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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELANIE JAYNE SCOTT
Title or Position: OWNER
Credential: LSW-I
Phone: 208-874-2962