Provider Demographics
NPI:1023268000
Name:SCOTT, GERALD WAYNE (BA)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:WAYNE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:BA
Other - Prefix:MR
Other - First Name:GERALD
Other - Middle Name:WAYNE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:2200 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-5800
Mailing Address - Country:US
Mailing Address - Phone:405-528-1748
Mailing Address - Fax:405-528-1802
Practice Address - Street 1:2200 N CLASSEN BLVD STE E
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5800
Practice Address - Country:US
Practice Address - Phone:405-528-1748
Practice Address - Fax:405-528-1802
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor