Basic Information
Provider Information | |||||||||
NPI: | 1972154573 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCOTT | ||||||||
FirstName: | DELBERT | ||||||||
MiddleName: | CHRISTOPHER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | ED.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SCOTT | ||||||||
OtherFirstName: | D | ||||||||
OtherMiddleName: | CHRISTOPHER | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | ED.D | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 30706 | ||||||||
Address2: |   | ||||||||
City: | GAHANNA | ||||||||
State: | OH | ||||||||
PostalCode: | 432300706 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6145357773 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1336 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432052081 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6149148781 | ||||||||
FaxNumber: | 6149148491 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/25/2019 | ||||||||
LastUpdateDate: | 09/25/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X |   |   | Y |   | Other Service Providers | Case Manager/Care Coordinator |   |
No ID Information.