Healthcare Provider Details

I. General information

NPI: 1013220037
Provider Name (Legal Business Name): SCOT R MACOMBER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 GULF FWY SOUTH SUITE B PMB 186
LEAGUE CITY TX
77573
US

IV. Provider business mailing address

614 DUNLAVY LN
LEAGUE CITY TX
77573-1522
US

V. Phone/Fax

Practice location:
  • Phone: 346-871-9161
  • Fax:
Mailing address:
  • Phone: 832-656-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62942
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: