Healthcare Provider Details

I. General information

NPI: 1487185757
Provider Name (Legal Business Name): SCOTT MCCONNELL M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 DEER VALLEY DR
PARK CITY UT
84060-5182
US

IV. Provider business mailing address

PO BOX 683480
PARK CITY UT
84068-3480
US

V. Phone/Fax

Practice location:
  • Phone: 435-649-2260
  • Fax: 435-649-2268
Mailing address:
  • Phone: 435-649-2260
  • Fax: 435-649-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10237464-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: