Healthcare Provider Details

I. General information

NPI: 1174792717
Provider Name (Legal Business Name): WILLIAM TRACY SCOTT MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CHASE PARK
LOGANSPORT IN
46947-1553
US

IV. Provider business mailing address

909 LAKEVIEW DR
LOGANSPORT IN
46947-2208
US

V. Phone/Fax

Practice location:
  • Phone: 574-732-1166
  • Fax: 574-753-4117
Mailing address:
  • Phone: 574-732-1166
  • Fax: 574-753-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: