Healthcare Provider Details

I. General information

NPI: 1699609230
Provider Name (Legal Business Name): HAYWOOD WATKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17235 N 75TH AVE
GLENDALE AZ
85308-0831
US

IV. Provider business mailing address

15031 W HEARN RD
SURPRISE AZ
85379-6034
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-1165
  • Fax:
Mailing address:
  • Phone: 480-641-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: