Provider Demographics
NPI:1497365837
Name:WILSON, SCOTT D (LCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:WILSON
Suffix:
Gender:M
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5486 W US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-8803
Mailing Address - Country:US
Mailing Address - Phone:317-947-6400
Mailing Address - Fax:
Practice Address - Street 1:5486 W US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-8803
Practice Address - Country:US
Practice Address - Phone:317-947-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000719A1041C0700X
IN34001913A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN87000719AOtherMEDICAL LICENSE
IN34001913AOtherMEDICAL LICENSE