=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407509581
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNDA JEANETTE WATT MS, LPC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2022
-----------------------------------------------------
Last Update Date | 01/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11429 W MISSION POINTE DR
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83651-8237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-850-0070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11429 W MISSION POINTE DR
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83651-8237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-850-0070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPC-8033
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------