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General NPI Number Information
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NPI Number | 1639676208
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Entity Type | Individual
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Provider Name | JOHN MITCHELL WATERS PH.D, LPC-MHSP
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Gender | Male
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 1004 HICKORY HILL LN
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City | HERMITAGE
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State | TN
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Zip | 37076-1930
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Country | US
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Telephone | 423-499-9335
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Fax |
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Provider Business Mailing Address
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Address Line | 1953 WELSENBORO CIR
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City | HERMITAGE
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State | TN
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Zip | 37076-3343
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Country | US
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Telephone | 423-443-5605
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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