Wyatt J Ezechiels, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2016007579 Issued in MO

Practice address

4731 S Cochise Dr Ste 206
Independence, MO 64055-6975

Phone

(816) 373-6433

NPI assigned

Oct 23, 2017

Last updated

Oct 23, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Kansas City Psychiatric and Psychological Services, LLC

  • Psychiatry Physician
  • Independence, MO
  • NPI 1033301148

  Professional

  NPD (past)
• Memoir Counseling, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Independence, MO
  • NPI 1578192308
  NPD (past)

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508716800000",
    "number": "1750892360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4731 S COCHISE DR STE 206",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4731 S COCHISE DR STE 206",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556975",
            "telephone_number": "816-373-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZECHIELS",
        "first_name": "WYATT",
        "middle_name": "J",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-23",
        "last_updated": "2017-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2016007579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Cedric Evans Jr., M.D.
• Shawna Lynn Evans, D.C.
• Eye Care LLC (Discover Vision Centers)
• Eye Care, LLC (Discover Vision Centers)
• Eyeconic Eyecare LLC
• Savannah Faapouli
• Julie Faddis, MSCAT, LPC
• Family Care & Wellness LLC
• Damiah Fanning
• Ali Farah

• Professional Counselor in Independence, MO
• Providers in Independence, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; 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.