Healthcare Provider Details

I. General information

NPI: 1144135641
Provider Name (Legal Business Name): JOSEPH BRIAN WATHEN CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S 4TH ST # PA
PADUCAH KY
42003-1504
US

IV. Provider business mailing address

209 E 21ST ST
BENTON KY
42025-1726
US

V. Phone/Fax

Practice location:
  • Phone: 270-415-5155
  • Fax:
Mailing address:
  • Phone: 270-519-3940
  • Fax: 270-519-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number297399
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: