Provider Demographics
NPI:1710516737
Name:WOOLLEY, SCOTT ROLAND (PHD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ROLAND
Last Name:WOOLLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24742 BJOIN RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-4654
Mailing Address - Country:US
Mailing Address - Phone:760-271-3632
Mailing Address - Fax:
Practice Address - Street 1:10065 OLD GROVE RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1664
Practice Address - Country:US
Practice Address - Phone:760-271-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37622106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist