Individual
JASON WAYNE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
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
(575) 642-5544
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0134631
NM
101YP2500X
Professional Counselor
Primary
CCMH0175961
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18677037
—
NM
Enumeration date
03/07/2011
Last updated
09/07/2021
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