Provider Demographics
NPI:1396352571
Name:WOOD, SCOTT (CMHC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 RIVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7726
Mailing Address - Country:US
Mailing Address - Phone:801-342-3473
Mailing Address - Fax:801-226-8298
Practice Address - Street 1:5455 RIVER RUN DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7726
Practice Address - Country:US
Practice Address - Phone:801-342-3473
Practice Address - Fax:801-226-8298
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6227119-6004101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor