Basic Information
| Provider Information | |||||||||
| NPI: | 1588025001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENASCO | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 865 MITCHELL AVE | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959654646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305387277 | ||||||||
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| Practice Location | |||||||||
| Address1: | 509 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945091653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257779540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2016 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 111342 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.