Provider Demographics
NPI:1194797928
Name:MARRS, SCOTT RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RICHARD
Last Name:MARRS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 MARSEILLE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3329
Mailing Address - Country:US
Mailing Address - Phone:505-828-0274
Mailing Address - Fax:
Practice Address - Street 1:2050 2ND ST SE
Practice Address - Street 2:
Practice Address - City:KIRTLAND AFB
Practice Address - State:NM
Practice Address - Zip Code:87117-5524
Practice Address - Country:US
Practice Address - Phone:505-846-2605
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical