Organization
JASON WYATT, LPCC, LLC
Active
Other names
Excelsior Mental Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
JASON WYATT (OWNER/THERAPIST)
(575) 642-5544
Entity
Organization
Contact information
Practice address
1705 N VALLEY DR STE 12, LAS CRUCES, NM 88007-5121
(575) 642-5544
Mailing address
PO BOX 375, FAIRACRES, NM 88033-0375
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61121282
—
NM
Enumeration date
06/23/2021
Last updated
09/07/2021
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