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General NPI Number Information
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NPI Number | 1245760404
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Entity Type | Individual
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Provider Name | ROGER SCOTT UTTER MS, LPC (TEMP.)
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Gender | Male
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 06/19/2017
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Provider Practice Location Address
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Address Line | 1604 WESTGATE CIR
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City | BRENTWOOD
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State | TN
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Zip | 37027-1300
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Country | US
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Telephone | 731-225-9684
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 WESTGATE CIR
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City | BRENTWOOD
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State | TN
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Zip | 37027-1300
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3794
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License Number State | TN
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