Scott D Wylie, Psy.D., MSCP, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

2962 Issued in CO

Legal business name

SCOTT D WYLIE, PSY.D., MSCP, LLC

Practice address

113 Coronado CT
Suite 202
Fort Collins, CO 80525-4911

Phone

(888) 666-0974

Fax

(970) 223-4433

NPI assigned

Apr 11, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Scott Devere Wylie, PSY.D., MSCPNPI 1669497111

Title

Owner

Phone

(888) 666-0974

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Medical Psychology Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scott Devere Wylie, PSY.D., MSCP

  • Clinical Neuropsychologist
  • Fort Collins, CO
  • NPI 1669497111
  Medicare reassignment Authorized official
• Dianne V. Lowe-Carpenter, LCSW

  • Clinical Social Worker
  • Cheyenne, WY
  • NPI 1114286895
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523059200000",
    "number": "1629411319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 CORONADO CT",
            "address_2": "SUITE 202",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254911",
            "telephone_number": "888-666-0974",
            "fax_number": "970-223-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 CORONADO CT",
            "address_2": "SUITE 202",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254911",
            "telephone_number": "888-666-0974",
            "fax_number": "970-223-4433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT D WYLIE, PSY.D., MSCP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-11",
        "last_updated": "2018-04-07",
        "status": "A",
        "authorized_official_last_name": "WYLIE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "DEVERE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-666-0974",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D., MSCP"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CO",
            "license": "2962",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "2962",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "CO",
            "license": "2962",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CO",
            "license": "2962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629411319",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135497300",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1669497111",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Psychology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aileen Michelle Scoggins
• Lynissa Scoggins
• Scott a. Haugen, O.D.
• Scott Blunk Lac LLC
• Scott Chiropractic Fort Collins P.C.
• Scott McNairy DDS PLLC
• Desirea Scott-Moore, DDS
• Brandi L Scott
• Christopher R Scott
• David Scott

• Multi-Specialty Clinic/Center in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Multi-Specialty Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.