Healthcare Provider Details

I. General information

NPI: 1477050102
Provider Name (Legal Business Name): SCOTT VAN NOTE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 ACEQUIA MADRE
SANTA FE NM
87505-2802
US

IV. Provider business mailing address

446 ACEQUIA MADRE
SANTA FE NM
87505-2802
US

V. Phone/Fax

Practice location:
  • Phone: 301-704-9878
  • Fax:
Mailing address:
  • Phone: 301-704-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0194791
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: