Healthcare Provider Details

I. General information

NPI: 1902718364
Provider Name (Legal Business Name): AMY MARIE WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SILVERTON RD NE
SALEM OR
97301-0100
US

IV. Provider business mailing address

3160 CENTER ST NE
SALEM OR
97301-4530
US

V. Phone/Fax

Practice location:
  • Phone: 503-576-2894
  • Fax:
Mailing address:
  • Phone: 503-585-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18575
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: