Healthcare Provider Details

I. General information

NPI: 1407661887
Provider Name (Legal Business Name): SCOUT SAVOY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 BOONVILLE RD
BRYAN TX
77808-2326
US

IV. Provider business mailing address

3902 BROWNWAY CT
COLLEGE STATION TX
77845-2208
US

V. Phone/Fax

Practice location:
  • Phone: 979-703-1808
  • Fax:
Mailing address:
  • Phone: 225-439-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number40429
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: