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General NPI Number Information
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NPI Number | 1750630760
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Entity Type | Individual
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Provider Name | STACIE WATTS MS, LCMFT
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Gender | Female
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 520 S HOLLAND ST SUITE 401
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City | WICHITA
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State | KS
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Zip | 67209-2096
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Country | US
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Telephone | 316-729-9965
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Fax |
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Provider Business Mailing Address
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Address Line | 520 S HOLLAND ST STE 401
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City | WICHITA
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State | KS
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Zip | 67209-2096
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LCMFT 753
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License Number State | KS
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