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General NPI Number Information
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NPI Number | 1538533138
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Entity Type | Organization
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Legal Business Name | SCOTT W. TRYLCH
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 579 N WILDERNESS DR
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City | MIDLAND
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State | MI
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Zip | 48640-8628
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Country | US
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Telephone | 989-631-6990
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Fax | 989-837-3108
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Provider Business Mailing Address
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Address Line | 579 N WILDERNESS DR
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City | MIDLAND
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State | MI
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Zip | 48640-8628
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Country | US
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Telephone | 989-631-6990
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Fax | 989-837-3108
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Authorized Official
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Title or Position | LICENSED PSYCHOLGIST
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Name | SCOTT TRYLCH
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Credential | EDD
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Telephone | 989-631-6990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 6301001438
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License Number State | MI
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