Provider Demographics
NPI:1346405826
Name:SCOTT, BRIAN RANDALL (LPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:RANDALL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N GRAND ST STE C
Mailing Address - Street 2:
Mailing Address - City:SCHOOLCRAFT
Mailing Address - State:MI
Mailing Address - Zip Code:49087-9203
Mailing Address - Country:US
Mailing Address - Phone:269-858-8722
Mailing Address - Fax:
Practice Address - Street 1:413 N GRAND ST STE C
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087-9203
Practice Address - Country:US
Practice Address - Phone:269-858-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085227104100000X
MI6401011435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1708146Medicaid