Healthcare Provider Details

I. General information

NPI: 1477666253
Provider Name (Legal Business Name): SHARON EILEEN WATTERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 CENTENNIAL BLVD
SPRINGFIELD OR
97477-3363
US

IV. Provider business mailing address

687 CHESHIRE AVE
EUGENE OR
97402-5060
US

V. Phone/Fax

Practice location:
  • Phone: 541-762-4551
  • Fax: 541-726-2467
Mailing address:
  • Phone: 541-684-4100
  • Fax: 541-684-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4424
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0003580
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: