Organization
SCOTT D WYLIE, PSY.D., MSCP, LLC
Active
Other names
Medical Psychology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT DEVERE WYLIE PSY.D., MSCP (OWNER)
(888) 666-0974
Entity
Organization
Contact information
Practice address
113 CORONADO CT, SUITE 202, FORT COLLINS, CO 80525-4911
(888) 666-0974
(970) 223-4433
Mailing address
113 CORONADO CT, SUITE 202, FORT COLLINS, CO 80525-4911
(888) 666-0974
(970) 223-4433
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
2962
CO
103TC0700X
Clinical Psychologist
2962
CO
103TP0016X
Prescribing (Medical) Psychologist
2962
CO
261QM1300X
Multi-Specialty Clinic/Center
Primary
2962
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135497300
—
WY
05
—
1629411319
—
CO
01
—
1669497111
INDIVIDUAL NPI
CO
Enumeration date
04/11/2013
Last updated
04/07/2018
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