MEDICARE: SCOTT HEREFORD

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	LH00011187	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497805667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT HEREFORD

Provider Business Mailing Address
First Line	:	PO BOX 959
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98907-0959
Country	:	US
Telephone Number	:	509-575-4084
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 N PEARL ST STE E
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-2938
Country	:	US
Telephone Number	:	509-925-7507
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	12/05/2023

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Directions to “ SCOTT HEREFORD ” Practice Location

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