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General NPI Number Information
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NPI Number | 1043485857
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Entity Type | Individual
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Provider Name | LORA J WATKINS LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 14217 S TEMPEST RIDGE CIR
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City | HERRIMAN
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State | UT
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Zip | 84096-1873
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Country | US
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Telephone | 152-010-6219
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Fax | 844-903-2824
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Provider Business Mailing Address
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Address Line | 14217 S TEMPEST RIDGE CIR
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City | HERRIMAN
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State | UT
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Zip | 84096-1873
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Country | US
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Telephone | 915-201-0621
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Fax | 844-903-2824
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5208-C
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09926552
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 58506
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License Number State | TX
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