Individual
DR. CHARLES BRADY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PD.D.
Contact information
Practice address
9316 E RAINTREE DR, STE 130, SCOTTSDALE, AZ 85260-3007
(480) 778-0202
(480) 778-0204
Mailing address
9316 E RAINTREE DR, SUITE 130, SCOTTSDALE, AZ 85260-3005
(480) 778-0202
(480) 778-0204
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1213
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188531100
DOL - OWCP
AZ
Enumeration date
04/06/2007
Last updated
06/20/2016
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