Healthcare Provider Details

I. General information

NPI: 1609188317
Provider Name (Legal Business Name): DIANE E SCOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 FIRST PARK TEN BLVD STE 222
SAN ANTONIO TX
78213-4308
US

IV. Provider business mailing address

835 GOLDEN HILLS RD
COLORADO SPRINGS CO
80919-8155
US

V. Phone/Fax

Practice location:
  • Phone: 210-496-2323
  • Fax:
Mailing address:
  • Phone: 719-393-3922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992899
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: