Organization
FOUNTAINGATE WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT D WYKES (OWNER)
(360) 653-0374
Entity
Organization
Contact information
Practice address
1106 COLUMBIA AVE STE 100, MARYSVILLE, WA 98270-4311
(360) 653-0374
Mailing address
1106 COLUMBIA AVE STE 100, MARYSVILLE, WA 98270-4311
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/18/2022
Last updated
02/18/2022
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