Healthcare Provider Details

I. General information

NPI: 1699293837
Provider Name (Legal Business Name): RUTH WATKINS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 MAIN AVE STE 205
DURANGO CO
81301-5132
US

IV. Provider business mailing address

1497 HERITAGE RD.
HESPERUS CO
81326-8708
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-7337
  • Fax: 970-259-7366
Mailing address:
  • Phone: 720-201-5867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number117246
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2378
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: