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General NPI Number Information
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NPI Number | 1831517630
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Entity Type | Individual
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Provider Name | MICHAEL WATHEN MA, LCPC, CAADC
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Gender | Male
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 210 N HAMMES AVE
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City | JOLIET
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State | IL
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Zip | 60435-6680
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Country | US
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Telephone | 815-322-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 930 S CEDAR RD
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City | NEW LENOX
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State | IL
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Zip | 60451-2207
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Country | US
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Telephone | 309-287-5270
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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 | 180011043
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License Number State | IL
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