MEDICARE: MR. WAYNE ANTHONY WILKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1851935886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAYNE ANTHONY WILKS

Provider Business Mailing Address
First Line	:	985 SEAWAY DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-2744
Country	:	US
Telephone Number	:	407-545-1258
Fax Number	:

Provider Business Practice Location Address
First Line	:	985 SEAWAY DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-2744
Country	:	US
Telephone Number	:	407-545-1258
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2019
Last Update Date	:	08/27/2024

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