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Individual
ERIC LEE SCOTT
Active
Individual
ERIC LEE SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20041809A
IN
103TC0700X
Clinical Psychologist
6301016582
MI
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
6301016582
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000267324
ANTHEM
IN
05
—
200411370
—
IN
Enumeration date
06/02/2006
Last updated
11/11/2020
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