Healthcare Provider Details

I. General information

NPI: 1013937820
Provider Name (Legal Business Name): JAMES WOODROW WATTS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E MAIN STREET
MOREHEAD KY
40351
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 606-784-4161
  • Fax: 606-783-9952
Mailing address:
  • Phone: 606-329-8588
  • Fax: 606-329-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberKY1813
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: