Individual
SCOTT MICHAEL CHARLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2215 BLUE GUM AVE, MODESTO, CA 95358-1052
(209) 573-1981
(209) 525-5498
Mailing address
2215 BLUE GUM AVE, MODESTO, CA 95358-1052
(209) 573-1981
(209) 525-5498
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
IMF89161
CA
106H00000X
Marriage & Family Therapist
IMF89161
CA
Other
Enumeration date
07/22/2013
Last updated
01/04/2022
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