Provider Demographics
NPI:1174571384
Name:KAMILAR, SCOTT MITCHEL (PHD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:MITCHEL
Last Name:KAMILAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8085 WAYZATA BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1459
Mailing Address - Country:US
Mailing Address - Phone:612-296-7942
Mailing Address - Fax:763-231-1704
Practice Address - Street 1:1409 WILLOW ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2269
Practice Address - Country:US
Practice Address - Phone:612-870-1242
Practice Address - Fax:612-870-8077
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN749250200Medicaid
MN749250200Medicaid