Jason Wayne Wyatt, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CCMH0175961 Issued in NM

Practice address

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

Phone

(575) 642-5544

NPI assigned

Mar 7, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Jason Wyatt, LPCC, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Las Cruces, NM
  • NPI 1336718287
  NPD Authorized official
• Cyfd-State of New Mexico-TCM

  • Case Management Agency
  • Albuquerque, NM
  • NPI 1710053293
  NPD (past)
• NM Children, Youth & Families Department - Juvenile Justice Services

  • Case Management Agency
  • Albuquerque, NM
  • NPI 1437967734
  NPD (past)

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

{
    "created_epoch": "1299456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1760780241",
    "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",
            "telephone_number": "575-642-5544"
        },
        {
            "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": [
        {
            "address_1": "10015 Robert Larson",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880079005",
            "country_code": "US",
            "telephone_number": "575-526-5900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYATT",
        "first_name": "JASON",
        "middle_name": "WAYNE",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-07",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "0134631",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NM",
            "license": "CCMH0175961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18677037",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jason@excelsiormhs.com",
            "affiliation": "Y",
            "affiliationName": "Jason Wyatt, LPCC, LLC",
            "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": []
}

• Shadoe Wright
• Amanda Wrobel
• Susie Wu, BT
• Ari Wunderlich
• John Wuthrich, DO
• Barbie L Wylie, LMSW
• Alexus Wynn
• Jessica Wyntjes
• Valerie Yanaga, CASE MANAGER
• Diana Yandell, RN

• Professional Counselor in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Professional Counselor 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.