Provider Demographics
NPI:1538533138
Name:SCOTT W. TRYLCH
Entity type:Organization
Organization Name:SCOTT W. TRYLCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLGIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYLCH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:989-631-6990
Mailing Address - Street 1:579 N WILDERNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8628
Mailing Address - Country:US
Mailing Address - Phone:989-631-6990
Mailing Address - Fax:989-837-3108
Practice Address - Street 1:579 N WILDERNESS DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-8628
Practice Address - Country:US
Practice Address - Phone:989-631-6990
Practice Address - Fax:989-837-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001438302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization