Individual ProviderJason Wayne WyattCounselorBehavioral Health & Social Service ProvidersPractice Address1705 N Valley Dr Ste 12, Las Cruces, NM 88007-5121(575) 642-5544PECOS EnrollmentBased on the most recent information from CMS, provider Jason Wayne Wyatt 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 ID1760780241Provider TypeIndividualFull NameWyatt, Jason WayneCredentialLPCCGenderMaleSole ProprietorNoEnumeration Date3/7/2011Last Updated9/7/2021Contact InformationPractice LocationPractice Address1705 N Valley Dr Ste 12, Las Cruces, NM 88007-5121Phone(575) 642-5544FaxUnlisted FaxMailing LocationMailing AddressPO Box 375, Fairacres, NM 88033-0375Phone(575) 642-5544FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseCCMH0175961New MexicoCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicense0134631New MexicoProvider IdentifiersIDDescriptionIssuerID18677037DescriptionMedicaidIssuerUnlistedNew Mexico