Doctor Name: | KATHY WATT |
NPI Number: | 1659312809 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | 6301007946 |
Business Practice Address: | 930 Blue Star Hwy South Haven, MI - 490907758 |
Business Phone Number: | 2696371115 |
Business Fax Number: | |
Mailing Address: | 930 Blue Star Hwy, Clinic Billing Department SOUTH HAVEN |
State: | MI |
Postal Code: | 490907758 |
Phone Number: | 2696371115 |
Fax Number: | |
NPI Enumeration Date: | 06/09/2006 |
NPI Last Update Date: | 09/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 6301007946 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |