Provider Demographics
NPI:1366577645
Name:SCOVILLE, ALICE FAYE (EDD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:FAYE
Last Name:SCOVILLE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 N COLLINS BLVD
Mailing Address - Street 2:SUITE 509
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2658
Mailing Address - Country:US
Mailing Address - Phone:972-699-9991
Mailing Address - Fax:972-234-2899
Practice Address - Street 1:2007 N COLLINS BLVD
Practice Address - Street 2:SUITE 509
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2658
Practice Address - Country:US
Practice Address - Phone:972-699-9991
Practice Address - Fax:972-234-2899
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2837LCOtherBLUE CROSS BLUE SHIELD
TX059419OtherVALUE OPTIONS
TX218600OtherAETNA
TX4229143OtherMAGELLAN