Healthcare Provider Details

I. General information

NPI: 1114450293
Provider Name (Legal Business Name): HEATHER SCOTT PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 E 13TH AVE STE 105
EUGENE OR
97401-4250
US

IV. Provider business mailing address

PO BOX 50368
EUGENE OR
97405-0978
US

V. Phone/Fax

Practice location:
  • Phone: 541-543-1702
  • Fax:
Mailing address:
  • Phone: 541-543-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1571
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HEATHER SCOTT
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 541-543-1702