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Amanda M. Wyatt, Llc

Counselor

Behavioral Health & Social Service Providers

2005 Valparaiso St Ste 107, Valparaiso, IN 46383-3330

PECOS Enrollment

Based on the most recent information from CMS, provider Amanda M. Wyatt, Llc 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
1912417601
Provider Type
Organization
Full Name
Amanda M. Wyatt, Llc

Subpart
No
Enumeration Date
10/6/2017
Last Updated
10/6/2017

Contact Information

Practice Location

2005 Valparaiso St Ste 107, Valparaiso, IN 46383-3330

(219) 929-6205

Unlisted Fax

Mailing Location

3205 Clairborne Xing, Valparaiso, IN 46385-2970

(219) 929-6205

Unlisted Fax

Authorized Official

Wyatt, Amanda M (Owner)

(219) 929-6205

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License 39001619A Indiana

Amanda M. Wyatt, Llc

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Sheets, Jonathan

Joseph, Reagan Carolyn

Schmidtke, Sarah

Jackson-Musenja, Nicole Toyi

Antone, Adam

Bridge To Peace Counseling, Llc

Kutemeier, Bethany Marie

Mclaughlin, Ashley

Wyatt, Amanda M

Williams, Gina