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General NPI Number Information
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NPI Number | 1003154170
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Entity Type | Individual
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Provider Name | ROBERT K. WAATSA L.P.C.C., L.A.D.A.C.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 20 RT 301 NORTH
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City | ZUNI
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State | NM
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Zip | 87327
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Country | US
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Telephone | 505-782-5719
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Fax | 505-782-5735
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | ZUNI
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State | NM
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Zip | 87327-0339
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Country | US
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Telephone | 505-782-5719
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Fax | 505-782-5735
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0159721
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0156201
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CCMH0208201
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License Number State | NM
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