Healthcare Provider Details

I. General information

NPI: 1740325752
Provider Name (Legal Business Name): SCOTT D. WYKES PHD, LMHC, CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 COLUMBIA AVE
MARYSVILLE WA
98270-4335
US

IV. Provider business mailing address

1106 COLUMBIA AVE
MARYSVILLE WA
98270-4335
US

V. Phone/Fax

Practice location:
  • Phone: 360-653-0374
  • Fax: 360-658-0219
Mailing address:
  • Phone: 360-653-0374
  • Fax: 360-658-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00004138
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00007178
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: