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NPI Code Detail

MEDICARE: MS. JEANNETTE WATTLEY

MEDICARE:  MS. JEANNETTE  WATTLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1144782327
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEANNETTE WATTLEY
Provider Business Mailing Address
First Line : 7941 CASTLEWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-1953
Country : US
Telephone Number : 317-205-8260
Fax Number : 866-850-5142
Provider Business Practice Location Address
First Line : 7941 CASTLEWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-1953
Country : US
Telephone Number : 317-205-8260
Fax Number : 866-850-5142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2019
Last Update Date : 04/04/2019

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Directions to “ MS. JEANNETTE WATTLEY ” Practice Location

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