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General NPI Number Information
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NPI Number | 1891426508
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Entity Type | Organization
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Legal Business Name | PATRICE SCOTT LMFT
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 9431 HAVEN AVE STE 100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5879
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Country | US
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Telephone | 909-257-7169
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Fax |
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Provider Business Mailing Address
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Address Line | 11660 CHURCH ST APT 34
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8919
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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 | OWNER/LMFT
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Name | MISS PATRICE SCOTT
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Credential |
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Telephone | 840-209-8867
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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 |
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License Number State |
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