MEDICARE: SCOTT COUNSELING & CONSULTING, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

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	:	1720610942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT COUNSELING & CONSULTING, LLC

Provider Business Mailing Address
First Line	:	137 LARKSPUR LN
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005-3726
Country	:	US
Telephone Number	:	478-832-5461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 RUSSELL PKWY STE 2
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-5586
Country	:	US
Telephone Number	:	478-992-0194
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COURTNEY SCOTT
Credential	:	LPC
Telephone Number	:	478-842-5461

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/05/2020

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