Healthcare Provider Details

I. General information

NPI: 1427182203
Provider Name (Legal Business Name): ROY H. SCOTT LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE ROAD 571 #28
EL RITO NM
87530-0237
US

IV. Provider business mailing address

11A LEAPING POWDER RD
SANTA FE NM
87508-5923
US

V. Phone/Fax

Practice location:
  • Phone: 505-571-4728
  • Fax: 505-581-0030
Mailing address:
  • Phone: 505-581-4728
  • Fax: 505-581-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0093301
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: