MEDICARE: COURTNEY 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	9665	MA

General Provider Information

NPI Number	:	1396361374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY SCOTT

Provider Business Mailing Address
First Line	:	1000 JEFFERSON ST STE 2C
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24504-1724
Country	:	US
Telephone Number	:	781-786-7267
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	1666 MASSACHUSETTS AVE FL 2
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-5313
Country	:	US
Telephone Number	:	781-786-7267
Fax Number	:	617-807-0958

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

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	08/16/2020

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Directions to “ COURTNEY SCOTT ” Practice Location

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