Basic Information
| Provider Information | |||||||||
| NPI: | 1053776500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13658 TRAVIS ST | ||||||||
| Address2: | |||||||||
| City: | WALKER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707857406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252238293 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8706 JEFFERSON HWY STE A | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708092233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259269706 | ||||||||
| FaxNumber: | 2259269708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2015 | ||||||||
| LastUpdateDate: | 09/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1303 | LA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | 6618 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.