Healthcare Provider Details

I. General information

NPI: 1932029626
Provider Name (Legal Business Name): SCOTT C. FOURMAN LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5963 BOYMEL DR
FAIRFIELD OH
45014-5541
US

IV. Provider business mailing address

2069 APPLE RIDGE CT
MIDDLETOWN OH
45044-7961
US

V. Phone/Fax

Practice location:
  • Phone: 513-860-8380
  • Fax:
Mailing address:
  • Phone: 513-860-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0001813-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: