Healthcare Provider Details

I. General information

NPI: 1972884799
Provider Name (Legal Business Name): PATRICIA RUTH SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 COUNTRY CLUB LANE
PINEDALE WY
82941
US

IV. Provider business mailing address

PO BOX 856
PINEDALE WY
82941-0856
US

V. Phone/Fax

Practice location:
  • Phone: 970-948-3770
  • Fax: 307-367-2166
Mailing address:
  • Phone: 970-948-3770
  • Fax: 307-367-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1492
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: