Healthcare Provider Details

I. General information

NPI: 1477094431
Provider Name (Legal Business Name): SCOTT ESSE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 FORD STREET
LLANO TX
78643-1203
US

IV. Provider business mailing address

1203 FORD STREET
LLANO TX
78643-1203
US

V. Phone/Fax

Practice location:
  • Phone: 325-247-4477
  • Fax:
Mailing address:
  • Phone: 325-247-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number71144
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: