Jason Wyatt, LPCC, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

JASON WYATT, LPCC, LLC

Practice address

1705 N Valley Dr Ste 12
Las Cruces, NM 88007-5121

Phone

(575) 642-5544

NPI assigned

Jun 23, 2021

Organization subpart

No

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

Authorized official

Name

Jason WyattNPI 1760780241

Title

Owner/Therapist

Phone

(575) 642-5544

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Excelsior Mental Health Services Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Wayne Wyatt, LPCC

  • Professional Counselor
  • Las Cruces, NM
  • NPI 1760780241
  NPD Authorized official

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

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630972800000",
    "number": "1336718287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 375",
            "city": "FAIRACRES",
            "state": "NM",
            "postal_code": "880330375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 N VALLEY DR STE 12",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880075121",
            "telephone_number": "575-642-5544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASON WYATT, LPCC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "575-642-5544"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61121282",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jason@excelsiormhs.com",
            "affiliation": "N",
            "address_1": "1705 N Valley Dr Ste 12",
            "city": "Las Cruces",
            "state": "NM",
            "country_code": "US",
            "postal_code": "880075121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Excelsior Mental Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Excelsior Mental Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marie Jaramillo, CASE MANAGER
• Nick Jaramillo
• George Huhn Jarden Jr., M.D.
• Jardin de Los Ninos
• Jared J. Gonzales LLC
• Annie Jasso
• Candido Jasso
• Dora Jasso
• Shannon Jasso
• Trinidad Avalos Jasso Jr., RN

• All providers in Las Cruces, NM
• Mental Health Clinic/Center (Including Community Mental Health Center) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.