MEDICARE: MS. CHERYL ANDREA SCOTT LPC

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	101YP2500X	Professional Counselor	PRC 12	DC
2	101YP2500X	Professional Counselor	80319	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12433222	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972824415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL ANDREA SCOTT LPC

Provider Business Mailing Address
First Line	:	4421 PADRE COURT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5821
Country	:	US
Telephone Number	:	682-459-3094
Fax Number	:	817-423-7384

Provider Business Practice Location Address
First Line	:	4421 PADRE COURT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5821
Country	:	US
Telephone Number	:	682-459-3094
Fax Number	:	817-423-7384

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

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	07/22/2019

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