Provider Demographics
NPI:1154706158
Name:DR. TINA SCOTT LPC LLC
Entity type:Organization
Organization Name:DR. TINA SCOTT LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DHA, MA, LPC
Authorized Official - Phone:215-519-2531
Mailing Address - Street 1:112 EARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5529
Mailing Address - Country:US
Mailing Address - Phone:215-519-2531
Mailing Address - Fax:
Practice Address - Street 1:1445 CITY LINE AVE
Practice Address - Street 2:7B
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3831
Practice Address - Country:US
Practice Address - Phone:215-519-2531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty