Healthcare Provider Details

I. General information

NPI: 1477870079
Provider Name (Legal Business Name): DANELLE STEVENS-WATKINS PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 GLENRIDGE PARK PLACE STE 5
LOUISVILLE KY
40222-3452
US

IV. Provider business mailing address

6511 GLENRIDGE PARK PLACE STE 5
LOUISVILLE KY
40222-3452
US

V. Phone/Fax

Practice location:
  • Phone: 502-614-7600
  • Fax:
Mailing address:
  • Phone: 502-614-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1587
License Number StateKY

VIII. Authorized Official

Name: DR. DANELLE STEVENS-WATKINS
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 502-614-7600