Healthcare Provider Details

I. General information

NPI: 1326385394
Provider Name (Legal Business Name): CANDICE MARIE WATT MA ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DEANNE AVE STE 2
NEWCASTLE WY
82701-2936
US

IV. Provider business mailing address

PO BOX 70
UPTON WY
82730-0070
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-4456
  • Fax:
Mailing address:
  • Phone: 307-746-8635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPPC-1003
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: