Healthcare Provider Details

I. General information

NPI: 1063833200
Provider Name (Legal Business Name): JAN W SCOTT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7787 PINEMONT DR STE B
HOUSTON TX
77040-6216
US

IV. Provider business mailing address

PO BOX 550769
HOUSTON TX
77255-0769
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-9194
  • Fax:
Mailing address:
  • Phone: 713-686-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: