Healthcare Provider Details

I. General information

NPI: 1194946269
Provider Name (Legal Business Name): STEPHEN H WATHEN LPC, LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 470 BOX 283
HANAU APO AE
09165
DE

IV. Provider business mailing address

CMR 470 BOX 283
HANAU APO AE
09165
DE

V. Phone/Fax

Practice location:
  • Phone: 3228911
  • Fax: 322354
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2105
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14833
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: