Healthcare Provider Details

I. General information

NPI: 1245310317
Provider Name (Legal Business Name): SCOTT MICHAEL MCAWARD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 E GREGSON AVE
SALT LAKE CITY UT
84106
US

IV. Provider business mailing address

1612 E GREGSON AVE
SALT LAKE CITY UT
84106-3422
US

V. Phone/Fax

Practice location:
  • Phone: 801-808-2083
  • Fax:
Mailing address:
  • Phone: 801-808-2083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5844389-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: