Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2995 | CT |
Y | 103G00000X | Clinical Psychologist | 2996 | CT |
Y | 103TC0700X | Clinical Psychologist | 2996 | CT |
NPI | 1609176643 |
---|---|
Provider Name | Melanie Scott |
First Address | Mission Viejo, CA 92691-6314 |
Second Address | Mission Viejo, CA 92691-6314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 11/11/2013 |