Basic Information
| Provider Information | |||||||||
| NPI: | 1740325752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WYKES | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LMHC, CDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982704335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606530374 | ||||||||
| FaxNumber: | 3606580219 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982704335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606530374 | ||||||||
| FaxNumber: | 3606580219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP00004138 | WA | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | LH00007178 | WA | X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.