Healthcare Provider Details

I. General information

NPI: 1477922490
Provider Name (Legal Business Name): KRISTI WATSON M.S LCADC, CCTP, BIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E JOHN ROWAN BLVD STE 107
BARDSTOWN KY
40004
US

IV. Provider business mailing address

89 INDIAN SPRINGS TRCE
SHELBYVILLE KY
40065-8359
US

V. Phone/Fax

Practice location:
  • Phone: 502-331-6002
  • Fax: 502-331-6122
Mailing address:
  • Phone: 502-827-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADCADC00223243
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number167170
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: