Healthcare Provider Details

I. General information

NPI: 1912278565
Provider Name (Legal Business Name): AGNES MARIE SCOTT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N CAMPUS RDG
MIDLAND MI
48640-6123
US

IV. Provider business mailing address

4500 N CAMPUS RDG
MIDLAND MI
48640-6123
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-1364
  • Fax: 989-839-6221
Mailing address:
  • Phone: 989-839-1364
  • Fax: 989-839-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6801091971
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: