Basic Information
| Provider Information | |||||||||
| NPI: | 1366881328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | TABATHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1242 TILSTON | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | N9B3C7 | ||||||||
| CountryCode: | CA | ||||||||
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| Practice Location | |||||||||
| Address1: | 8623 N WAYNE RD | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481851137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343674069 | ||||||||
| FaxNumber: | 7343670791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2013 | ||||||||
| LastUpdateDate: | 08/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801094271 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.