MEDICARE: SCOTT GROUP 010 LLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1558122937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT GROUP 010 LLC

Provider Business Mailing Address
First Line	:	9250 N 43RD AVE STE 10
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3849
Country	:	US
Telephone Number	:	480-433-5593
Fax Number	:

Provider Business Practice Location Address
First Line	:	9250 N 43RD AVE STE 10
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3849
Country	:	US
Telephone Number	:	480-433-5593
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GARY A SCOTT SR.
Credential	:
Telephone Number	:	480-433-5593

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	05/21/2026

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Directions to “SCOTT GROUP 010 LLC ” Practice Location

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