Individual ProviderWyatt LewallenMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address43585 Monterey Ave Ste 1, Palm Desert, CA 92260-9398(760) 563-6623PECOS EnrollmentBased on the most recent information from CMS, provider Wyatt Lewallen does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1376353052Provider TypeIndividualFull NameLewallen, WyattCredentialLMFTGenderMaleSole ProprietorNoEnumeration Date1/13/2025Last Updated1/13/2025Contact InformationPractice LocationPractice Address43585 Monterey Ave Ste 1, Palm Desert, CA 92260-9398Phone(760) 563-6623FaxUnlisted FaxMailing LocationMailing Address43585 Monterey Ave Ste 1, Palm Desert, CA 92260-9398Phone(760) 563-6623FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense151457California