MEDICARE: JESSIE IVELYN SCOTT M.A. LMHC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH-15114
2	101YM0800X	Mental Health Counselor	MH-15114	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841599974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE IVELYN SCOTT M.A. LMHC

Provider Business Mailing Address
First Line	:	402 LOCHMOND DR
Second Line	:
City	:	FERN PARK
State	:	FL
Zip	:	32730-2636
Country	:	US
Telephone Number	:	407-486-0239
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 SABAL PALM DR STE 151
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-2593
Country	:	US
Telephone Number	:	407-486-0239
Fax Number	:

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

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/26/2019

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