Jedediah Walls, LMHC, ATR-P

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CTB-2022-0028 Issued in NM

Practice address

133 Wyatt Dr Ste 3
Las Cruces, NM 88005-2962

Phone

(575) 526-9878

NPI assigned

Mar 23, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Group practices

Counseling Las Cruces LLCGroup PAC ID 8820385271, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Counseling Las Cruces, LLC

  • Marriage & Family Therapist
  • Las Cruces, NM
  • NPI 1194107060
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1174272397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 GREENWOOD LN",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883105742",
            "telephone_number": "574-310-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 WYATT DR STE 3",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880052962",
            "telephone_number": "575-526-9878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "JEDEDIAH",
        "name_prefix": "Dr.",
        "credential": "LMHC, ATR-P",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-23",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CTB-2022-0028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jed@jedwalls.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1304 Greenwood Ln",
            "city": "Alamogordo",
            "state": "NM",
            "country_code": "US",
            "postal_code": "883105742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michelle Waller, RBT
• Wendi Cheree Wallin, DC
• Wallis Enterprises Inc
• Jared S. Wallis, DDS
• Leah Wallis
• Georgine Walsh, CF-SLP
• Stephanie Walterman
• Marcos Antonio Walters, RN
• Maria Leslie Wandemberg
• Hanna-Jen Wang

• Mental Health Counselor in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.