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General NPI Number Information
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NPI Number | 1619491685
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Entity Type | Organization
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Legal Business Name | CAC BUENA VISTA CENTER
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 400 W PARK AVE
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City | SANTA MARIA
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State | CA
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Zip | 93458-6116
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Country | US
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Telephone | 805-922-1439
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Fax | 805-925-5169
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Provider Business Mailing Address
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Address Line | 400 W PARK AVE
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City | SANTA MARIA
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State | CA
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Zip | 93458-6116
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Country | US
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Telephone | 805-922-1439
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Fax | 805-925-5169
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Authorized Official
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Title or Position | CLINICAL SERVICES DIRECTOR
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Name | DR. DAVID LAUREL SCOTT
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Credential | PSY.D., LMFT
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Telephone | 805-260-4676
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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 | 28718
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License Number State | CA
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