Look up the most recent NPI and PECOS records

Amanda M Wyatt

Counselor

Behavioral Health & Social Service Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Amanda M Wyatt does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1245221043
Provider Type
Individual
Full Name
Wyatt, Amanda M
Credential
MA, ATR-BC, LMHC

Gender
Female
Sole Proprietor
No
Enumeration Date
10/31/2005
Last Updated
6/1/2010

Contact Information

Practice Location

601 Wall St, Valparaiso, IN 46383-2512

(219) 531-3500

Unlisted Fax

Mailing Location

601 Wall St, Valparaiso, IN 46383-2512

(219) 531-3500

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License 39001619A Indiana
Code 101YP2500X	Description Counselor Behavioral Health & Social Service Providers	License 180-005554 Illinois

Provider Identifiers

ID	Description	Issuer
ID 180-005554	Description Other	Issuer LCPC Illinois
ID 39001619A	Description Other	Issuer LMHC Indiana
ID 04-139	Description Other	Issuer ART THERAPY BD. CERT.

Amanda M Wyatt

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Butler, Brent

Wasil, Patricia A

Sheets, Natalie Marie

Anderson, Thomas

Rice, Christina

Williams, Vera

Valtierra, Melissa E

Akre, Marilynn

Wardell, Nicholas

Ensley, Rodney