Provider Demographics
NPI:1588750830
Name:SCOTT, ANDREW W (LPC, LADC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:W
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E 19TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6627
Mailing Address - Country:US
Mailing Address - Phone:405-285-8226
Mailing Address - Fax:405-285-8227
Practice Address - Street 1:1616 E 19TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6627
Practice Address - Country:US
Practice Address - Phone:405-285-8226
Practice Address - Fax:405-285-8227
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional