Provider Demographics
NPI:1568295848
Name:SCOTT, RONDAL ELLIS (APSS)
Entity type:Individual
Prefix:
First Name:RONDAL
Middle Name:ELLIS
Last Name:SCOTT
Suffix:
Gender:M
Credentials:APSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1162
Mailing Address - Country:US
Mailing Address - Phone:270-723-5867
Mailing Address - Fax:
Practice Address - Street 1:429 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1149
Practice Address - Country:US
Practice Address - Phone:629-259-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)