Healthcare Provider Details

I. General information

NPI: 1043811292
Provider Name (Legal Business Name): SATYA WELLNESS COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 DAYTON ST STE 107B
EDMONDS WA
98020-3581
US

IV. Provider business mailing address

209 DAYTON ST STE 107B
EDMONDS WA
98020-3581
US

V. Phone/Fax

Practice location:
  • Phone: 360-768-4851
  • Fax:
Mailing address:
  • Phone: 360-768-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: DEZRYELLE CLOUSE
Title or Position: OWNER
Credential: LMFT
Phone: 360-768-4851