Provider Demographics
NPI:1114733706
Name:SCOTT, LANA JO
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:JO
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 FARA BIUNDO DR APT 8
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9562
Mailing Address - Country:US
Mailing Address - Phone:209-484-0513
Mailing Address - Fax:
Practice Address - Street 1:509 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-2406
Practice Address - Country:US
Practice Address - Phone:209-599-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling