| Scott D Wylie, Psy.d., Mscp, Llc | |
|
113 Coronado Ct Suite 202 Fort Collins CO 80525-4911 | |
| (888) 666-0974 | |
| (970) 223-4433 |
| Full Name | Scott D Wylie, Psy.d., Mscp, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 113 Coronado Ct, Fort Collins, Colorado |
| Authorized Official Name and Position | Scott Devere Wylie (OWNER) |
| Authorized Official Contact | 8886660974 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scott D Wylie, Psy.d., Mscp, Llc 113 Coronado Ct Suite 202 Fort Collins CO 80525-4911 Ph: (888) 666-0974 | Scott D Wylie, Psy.d., Mscp, Llc 113 Coronado Ct Suite 202 Fort Collins CO 80525-4911 Ph: (888) 666-0974 |
| NPI Number | 1629411319 |
|---|---|
| Provider Enumeration Date | 04/11/2013 |
| Last Update Date | 04/07/2018 |
| Medicare PECOS PAC ID | 4385880871 |
|---|---|
| Medicare Enrollment ID | O20130919000014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629411319 | NPI | - | NPPES |
| 1629411319 | Medicaid | CO | |
| 135497300 | Medicaid | WY | |
| 1669497111 | Other | CO | INDIVIDUAL NPI |
| Provider Name | Scott Devere Wylie |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669497111 PECOS PAC ID: 0547330722 Enrollment ID: I20080530000035 |
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