Provider Demographics
NPI:1104224658
Name:SCOTT, SHAD (MS)
Entity type:Individual
Prefix:
First Name:SHAD
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7341 W CHARLESTON BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1573
Mailing Address - Country:US
Mailing Address - Phone:702-710-5729
Mailing Address - Fax:
Practice Address - Street 1:7341 W CHARLESTON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1573
Practice Address - Country:US
Practice Address - Phone:702-710-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor