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General NPI Number Information
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NPI Number | 1063686699
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Entity Type | Individual
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Provider Name | DEWEY SCOTT MAYBERRY M.A. LMHC
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Gender | Male
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 4626 LORI LN
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City | PACE
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State | FL
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Zip | 32571-1560
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Country | US
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Telephone | 850-266-3025
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Fax | 850-944-9676
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Provider Business Mailing Address
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Address Line | 4626 LORI LN
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City | PACE
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State | FL
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Zip | 32571-1560
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Country | US
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Telephone | 850-266-3025
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Fax | 850-944-9676
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH7715
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License Number State | FL
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