Healthcare Provider Details

I. General information

NPI: 1316193840
Provider Name (Legal Business Name): SCOTT C. WINDHAM, LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 GREENTREE RD SUITE 102
PITTSBURGH PA
15220-3100
US

IV. Provider business mailing address

1016 GREENTREE RD SUITE 102
PITTSBURGH PA
15220-3100
US

V. Phone/Fax

Practice location:
  • Phone: 412-561-0311
  • Fax: 412-561-0511
Mailing address:
  • Phone: 412-561-0311
  • Fax: 412-561-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCW015984
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCW015984
License Number StatePA

VIII. Authorized Official

Name: MR. SCOTT CARTER WINDHAM
Title or Position: PRESIDENT
Credential: LCSW
Phone: 412-561-0311