| Doctor Name: | MR. ROBERT K. WAATSA |
| NPI Number: | 1003154170 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.M.H.C., L.A.D.A.C. |
| License Number: | 0159721 |
| Business Practice Address: | 101 D Avenue Black Rock Zuni, NM - 87327 |
| Business Phone Number: | 5057824710 |
| Business Fax Number: | 5057825880 |
| Mailing Address: | Po Box 339, Zuni Recovery Center ZUNI |
| State: | NM |
| Postal Code: | 873270339 |
| Phone Number: | 5057824710 |
| Fax Number: | 5057825880 |
| NPI Enumeration Date: | 01/24/2013 |
| NPI Last Update Date: | 07/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 0159721 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |