MEDICARE: TONY TERRELL SCOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		MS
2	101YM0800X	Mental Health Counselor	11032	LA
3	171M00000X	Case Manager/Care Coordinator
4	171M00000X	Case Manager/Care Coordinator		LA
5	101Y00000X	Counselor	11032	LA

General Provider Information

NPI Number	:	1295227114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY TERRELL SCOTT

Provider Business Mailing Address
First Line	:	4348 S JEFFREY DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4196
Country	:	US
Telephone Number	:	225-361-0219
Fax Number	:

Provider Business Practice Location Address
First Line	:	4348 S JEFFREY DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4196
Country	:	US
Telephone Number	:	225-361-0219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	05/19/2026

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