Provider Demographics
NPI:1740325752
Name:WYKES, SCOTT D (PHD, LMHC, CDP)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:WYKES
Suffix:
Gender:M
Credentials:PHD, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4335
Mailing Address - Country:US
Mailing Address - Phone:360-653-0374
Mailing Address - Fax:360-658-0219
Practice Address - Street 1:1106 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4335
Practice Address - Country:US
Practice Address - Phone:360-653-0374
Practice Address - Fax:360-658-0219
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004138101YA0400X
WALH00007178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health