MEDICARE: SCOTT DANIEL PICKENS

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	101Y00000X	Counselor	C.2103900	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C.2103900	OTHER	OH	LPC

General Provider Information

NPI Number	:	1821687914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT DANIEL PICKENS

Provider Business Mailing Address
First Line	:	311 ALBERT SABIN WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2838
Country	:	US
Telephone Number	:	513-558-9006
Fax Number	:	513-558-3880

Provider Business Practice Location Address
First Line	:	1239 CENTRAL AVE
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-4103
Country	:	US
Telephone Number	:	513-558-9006
Fax Number	:

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

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/17/2023

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Directions to “ SCOTT DANIEL PICKENS ” Practice Location

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