Individual
DR. SCOTT DEVERE WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D., MSCP
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, STE 202, FORT COLLINS, CO 80525-4911
(888) 666-0974
(970) 223-4433
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
2962
CO
103G00000X
Clinical Neuropsychologist
478
WY
103TC0700X
Clinical Psychologist
2962
CO
103TC0700X
Clinical Psychologist
478
WY
103TC0700X
Clinical Psychologist
PSY18408
CA
103TF0200X
Forensic Psychologist
2962
CO
103TH0004X
Health Psychologist
2962
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128459200
—
WY
01
—
1629411319
TYPE 2 NPI
CO
05
—
1669497111
—
CO
01
—
462318597
TAX ID
WY
Enumeration date
07/13/2006
Last updated
04/07/2018
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