Healthcare Provider Details

I. General information

NPI: 1821138488
Provider Name (Legal Business Name): ALAN VERN SCOTT LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 S MAIN ST
CHEBOYGAN MI
49721-2220
US

IV. Provider business mailing address

8820 GALBRAITH RD
CHEBOYGAN MI
49721-8501
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-7118
  • Fax:
Mailing address:
  • Phone: 231-625-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067671
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: