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General NPI Number Information
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NPI Number | 1699966572
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Entity Type | Organization
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Legal Business Name | SCHOOL BASED ASSESSMENT COUNSELING & CONSULTING
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 219 ROBIE ST E
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City | SAINT PAUL
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State | MN
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Zip | 55107-2325
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Country | US
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Telephone | 612-275-6982
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Fax |
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Provider Business Mailing Address
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Address Line | 219 ROBIE ST E
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City | SAINT PAUL
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State | MN
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Zip | 55107-2325
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Country | US
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Telephone | 612-275-6982
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY G. SCOTT
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Credential | LICSW
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Telephone | 612-275-6982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 8472
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License Number State | MN
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