=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932188091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICKI ELLEN SCOTT LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2006
-----------------------------------------------------
Last Update Date | 02/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21448 N 75TH AVE. #6
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-5978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-572-8053
-----------------------------------------------------
Fax | 855-894-0967
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21289 N 66TH LN
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-6413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-527-1319
-----------------------------------------------------
Fax | 855-894-0967
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC2452
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------