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General NPI Number Information
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NPI Number | 1548907066
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Entity Type | Individual
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Provider Name | VIVIAN WATTS
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Gender | Female
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 2612 LONG PRAIRIE RD
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4839
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Country | US
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Telephone | 972-895-2365
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Fax |
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Provider Business Mailing Address
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Address Line | 430 COUNTY ROAD 2788
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City | SUNSET
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State | TX
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Zip | 76270-3300
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Country | US
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Telephone | 214-422-4443
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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