Healthcare Provider Details

I. General information

NPI: 1326074279
Provider Name (Legal Business Name): RICHARD SCOTT PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 112A
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

10820 SUNSET OFFICE DR STE 122
SAINT LOUIS MO
63127-1029
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6545
  • Fax: 314-251-5808
Mailing address:
  • Phone: 314-994-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY01567
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01567
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: