Healthcare Provider Details

I. General information

NPI: 1174469498
Provider Name (Legal Business Name): SCOTT CHARLES KING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BURGESSVILLE RD
RUSTON LA
71270-5154
US

IV. Provider business mailing address

2301 TIMBERLINE CT APT G106
RUSTON LA
71270-5298
US

V. Phone/Fax

Practice location:
  • Phone: 318-224-7223
  • Fax: 318-415-1004
Mailing address:
  • Phone: 504-729-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: