| Doctor Name: | MR. SCOTT GOURSON |
| NPI Number: | 1578891990 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC,LADC,CCDP |
| License Number: | 000802 |
| Business Practice Address: | 1622 Farmington Ave Unit #5 Unionville, CT - 060851259 |
| Business Phone Number: | 8606736743 |
| Business Fax Number: | 8606736743 |
| Mailing Address: | 1622 Farmington Ave, Unit #5 UNIONVILLE |
| State: | CT |
| Postal Code: | 060851259 |
| Phone Number: | 8606736743 |
| Fax Number: | 8606736743 |
| NPI Enumeration Date: | 11/23/2009 |
| NPI Last Update Date: | 11/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 000802 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |