Scott Matthew Taubold, PH.D.

Key facts

NPI

1902944580

Entity type

Individual (NPI type 1)

Primary specialty

Psychologist 103T00000X

License

PSY20805 (CA)

Practice address

347 Cypress St Ste B
Fort Bragg, CA 95437-5458

Phone

(707) 964-5143

NPI assigned

Feb 3, 2007

Sex

Male

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bitterroot Family Therapy Inc. Mental Health Counselor · Fort Bragg, CA · NPI 1003401910
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

HHS exclusion list flag

The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Philosophy

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 17, 2012.

{
    "created_epoch": "1170460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350432000000",
    "number": "1902944580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 S FRANKLIN ST STE B",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375456",
            "telephone_number": "707-961-2669",
            "fax_number": "707-961-2698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "347 CYPRESS ST STE B",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375458",
            "telephone_number": "707-964-5143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAUBOLD",
        "first_name": "SCOTT",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-03",
        "last_updated": "2012-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY20805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Fort Bragg, CA · Psychologist in California