Healthcare Provider Details

I. General information

NPI: 1750762696
Provider Name (Legal Business Name): MICHELLE K SCOTT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 GALLERIA OAKS DR
TEXARKANA TX
75503-4617
US

IV. Provider business mailing address

1911 GALLERIA OAKS DR
TEXARKANA TX
75503-4617
US

V. Phone/Fax

Practice location:
  • Phone: 210-446-8255
  • Fax: 888-823-3497
Mailing address:
  • Phone: 903-792-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70723
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: