Provider Demographics
NPI:1972343267
Name:SCOTT, CHRISTOPHER COREY
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:COREY
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E PARK AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4328
Mailing Address - Country:US
Mailing Address - Phone:718-564-9618
Mailing Address - Fax:
Practice Address - Street 1:11901 TOEPPERWEIN RD STE 1202
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3159
Practice Address - Country:US
Practice Address - Phone:210-951-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health