Healthcare Provider Details

I. General information

NPI: 1659094985
Provider Name (Legal Business Name): DUSTIN M SCOTT LMHC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 E 17TH AVE
SPOKANE WA
99223-5136
US

IV. Provider business mailing address

3157 E 17TH AVE
SPOKANE WA
99223-5136
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-8066
  • Fax:
Mailing address:
  • Phone: 509-838-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61351290
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: