Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1073090700 |
---|---|
Provider Name | Scott Alan Wilson |
First Address | Fountain Hills, AZ 85268-1800 |
Second Address | Scottsdale, AZ 85254-4570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2018 |
Last Update Date | 25/07/2018 |