Individual ProviderJacqueline WastalCounselorBehavioral Health & Social Service ProvidersPractice Address5040 E Shea Blvd #164, Phoenix, AZ 85028(480) 641-1165(760) 500-8839PECOS EnrollmentBased on the most recent information from CMS, provider Jacqueline Wastal 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 yesterday at 12:57 PM.Profile DetailsProvider ID1669106290Provider TypeIndividualFull NameWastal, JacquelineGenderFemaleSole ProprietorNoEnumeration Date7/11/2022Last Updated7/11/2022Contact InformationPractice LocationPractice Address5040 E Shea Blvd #164, Phoenix, AZ 85028Phone(480) 641-1165FaxUnlisted FaxMailing LocationMailing Address15740 N 83rd Ave Apt 1035, Peoria, AZ 85382-3889Phone(760) 500-8839FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer