Healthcare Provider Details

I. General information

NPI: 1295227114
Provider Name (Legal Business Name): TONY TERRELL SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 S JEFFREY DR
BATON ROUGE LA
70816-4196
US

IV. Provider business mailing address

4348 S JEFFREY DR
BATON ROUGE LA
70816-4196
US

V. Phone/Fax

Practice location:
  • Phone: 225-361-0219
  • Fax:
Mailing address:
  • Phone: 225-361-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11032
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11032
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: