MEDICARE: MR. ROY H. SCOTT LPCC

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	0093301	NM

General Provider Information

NPI Number	:	1427182203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROY H. SCOTT LPCC

Provider Business Mailing Address
First Line	:	11A LEAPING POWDER RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-5923
Country	:	US
Telephone Number	:	505-581-4728
Fax Number	:	505-581-0030

Provider Business Practice Location Address
First Line	:	STATE ROAD 571
Second Line	:	#28
City	:	EL RITO
State	:	NM
Zip	:	87530-0237
Country	:	US
Telephone Number	:	505-571-4728
Fax Number	:	505-581-0030

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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