MEDICARE: MRS. DOVIE PAULINE WATFORD M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	CC0486	AZ

General Provider Information

NPI Number	:	1841244506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOVIE PAULINE WATFORD M.S.

Provider Business Mailing Address
First Line	:	19216 N 61ST AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7683
Country	:	US
Telephone Number	:	623-825-4650
Fax Number	:

Provider Business Practice Location Address
First Line	:	11225 N 28TH DR
Second Line	:	SUITE D213
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5606
Country	:	US
Telephone Number	:	602-993-4323
Fax Number	:	602-993-0867

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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