Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 553 | WY |
NPI | 1104378157 |
---|---|
Provider Name | Dr. Walter Scott |
First Address | Pullman, WA 99164-5840 |
Second Address | Pullman, WA 99164-5840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2016 |
Last Update Date | 25/10/2016 |