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General NPI Number Information
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NPI Number | 1982981247
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Entity Type | Organization
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Legal Business Name | SCOTT WILLOUGHBY, PHD, LLC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 1 COMMERCE DR SUITE 205
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City | HATTIESBURG
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State | MS
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Zip | 39402-1499
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Country | US
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Telephone | 601-466-1970
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16954
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City | HATTIESBURG
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State | MS
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Zip | 39404-6954
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Country | US
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Telephone | 601-466-1970
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. SCOTT WILLOUGHBY
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Credential | PHD
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Telephone | 601-466-1970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 41-003
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License Number State | MS
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