Healthcare Provider Details

I. General information

NPI: 1568385557
Provider Name (Legal Business Name): CARMEN WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 E EAGLE CREST DR STE 101
MESA AZ
85207-1041
US

IV. Provider business mailing address

4168 E FRENCH TROTTER ST
SAN TAN VALLEY AZ
85140-1662
US

V. Phone/Fax

Practice location:
  • Phone: 480-780-1235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: