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General NPI Number Information
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NPI Number | 1669497111
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Entity Type | Individual
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Provider Name | SCOTT DEVERE WYLIE PSY.D., MSCP
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 04/07/2018
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Provider Practice Location Address
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Address Line | 113 CORONADO CT SUITE 202
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City | FORT COLLINS
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State | CO
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Zip | 80525-4911
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Country | US
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Telephone | 888-666-0974
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Fax | 970-223-4433
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Provider Business Mailing Address
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Address Line | 113 CORONADO CT STE 202
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City | FORT COLLINS
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State | CO
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Zip | 80525-4911
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Country | US
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Telephone | 888-666-0974
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Fax | 970-223-4433
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 478
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY18408
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 478
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License Number State | WY
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2962
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 2962
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License Number State | CO
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Taxonomy #6
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 2962
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License Number State | CO
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Taxonomy #7
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2962
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License Number State | CO
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