Healthcare Provider Details

I. General information

NPI: 1700383965
Provider Name (Legal Business Name): LAUREN WATKINS M. ED LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 03/10/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ROLLING RIDGE DR STE 100
STATE COLLEGE PA
16801-7641
US

IV. Provider business mailing address

860 HILL ST
BELLEFONTE PA
16823-2747
US

V. Phone/Fax

Practice location:
  • Phone: 148-670-6708
  • Fax: 814-867-7616
Mailing address:
  • Phone: 814-934-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010272
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: