Healthcare Provider Details

I. General information

NPI: 1902321177
Provider Name (Legal Business Name): TERRY WAYNARD SCOTT LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5958 N CANTON CENTER RD STE 900
CANTON MI
48187-2740
US

IV. Provider business mailing address

26184 OUTER DR
LINCOLN PARK MI
48146-2084
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3633
Mailing address:
  • Phone: 313-389-7500
  • Fax: 313-389-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851105875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: