Healthcare Provider Details

I. General information

NPI: 1679207724
Provider Name (Legal Business Name): SCOTT BLAISE MCDOUGALL CH.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MINUTE MAN CT
EAST BRUNSWICK NJ
08816-3271
US

IV. Provider business mailing address

3 MINUTE MAN CT
EAST BRUNSWICK NJ
08816-3271
US

V. Phone/Fax

Practice location:
  • Phone: 609-865-7332
  • Fax:
Mailing address:
  • Phone: 609-865-7332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: