Provider Demographics
NPI:1992696488
Name:WILSON, SCOTT TIMOTHY (ASW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:TIMOTHY
Last Name:WILSON
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 BOSTONIAN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4237
Mailing Address - Country:US
Mailing Address - Phone:657-402-2687
Mailing Address - Fax:
Practice Address - Street 1:3171 BOSTONIAN DR
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-4237
Practice Address - Country:US
Practice Address - Phone:657-402-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW928691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical