Provider Demographics
NPI:1487795902
Name:SCURRY, WILLIAM CLARK (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLARK
Last Name:SCURRY
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 1:625 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-4275
Mailing Address - Country:US
Mailing Address - Phone:507-334-2892
Mailing Address - Fax:507-332-6947
Practice Address - Street 1:625 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4275
Practice Address - Country:US
Practice Address - Phone:507-334-2892
Practice Address - Fax:507-332-6947
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0645103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN48Q29SCOtherBHSI
MN122679OtherU-CARE
MN1016738OtherBHP
MN34304SCOtherBCBS
MNHP37271OtherHEALTHPARTNERS