Healthcare Provider Details

I. General information

NPI: 1407677917
Provider Name (Legal Business Name): DONALD SCOTT M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2533 N 700 W
ARLINGTON IN
46104-9410
US

IV. Provider business mailing address

976 N JENNIFER DR
GREENFIELD IN
46140-9546
US

V. Phone/Fax

Practice location:
  • Phone: 765-663-2416
  • Fax:
Mailing address:
  • Phone: 317-675-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1072064
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: