Healthcare Provider Details

I. General information

NPI: 1376364562
Provider Name (Legal Business Name): CHRISTOPHER JON WATTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 8TH ST STE 300
MODESTO CA
95354-2235
US

IV. Provider business mailing address

1231 8TH ST STE 300
MODESTO CA
95354-2235
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-7339
  • Fax:
Mailing address:
  • Phone: 209-525-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number101YP2500X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: