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General NPI Number Information
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NPI Number | 1790833051
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Entity Type | Individual
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Provider Name | LAURIE BOOTH WATKINS LCPC, LPC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 221 S METTER AVE
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City | COLUMBIA
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State | IL
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Zip | 62236-2253
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Country | US
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Telephone | 314-651-4313
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Fax |
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Provider Business Mailing Address
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Address Line | 3023 HIGHWAY K #615
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City | O FALLON
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State | MO
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Zip | 63368-8696
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Country | US
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Telephone | 314-651-4313
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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 | 180-004025
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2001005090
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License Number State | MO
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