Provider Demographics
NPI:1174153332
Name:ANDREWS, SCOTT EDMUND (MS)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:EDMUND
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 W TWIN PINE DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-6527
Mailing Address - Country:US
Mailing Address - Phone:574-297-1330
Mailing Address - Fax:
Practice Address - Street 1:105 S 225 E
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IN
Practice Address - Zip Code:46929-9688
Practice Address - Country:US
Practice Address - Phone:574-967-5138
Practice Address - Fax:574-967-4882
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1009883103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool