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General NPI Number Information
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NPI Number | 1053639583
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Entity Type | Individual
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Provider Name | KIM SCOTT ED.D
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Gender | Female
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 05/07/2010
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Provider Practice Location Address
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Address Line | 15643 DOBBS PEAK LN
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City | FONTANA
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State | CA
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Zip | 92336-4560
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Country | US
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Telephone | 951-536-7845
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Fax |
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Provider Business Mailing Address
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Address Line | 15643 DOBBS PEAK LN
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City | FONTANA
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State | CA
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Zip | 92336-4560
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Country | US
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Telephone | 951-536-7845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1538-061511P
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 070104802
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License Number State | CA
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