Healthcare Provider Details

I. General information

NPI: 1689711178
Provider Name (Legal Business Name): SHARON LEE SCOTT MA, LLP, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 KIRTS BLVD
TROY MI
48084-4881
US

IV. Provider business mailing address

919 ASPEN DR
ROCHESTER MI
48307-1006
US

V. Phone/Fax

Practice location:
  • Phone: 248-656-7056
  • Fax:
Mailing address:
  • Phone: 248-651-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401006046
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301009757
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: