MEDICARE: VANESSA LANE WATTS LPC

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
1	101Y00000X	Counselor	65841	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65841	OTHER	TX	TEXAS LICENSE

General Provider Information

NPI Number	:	1164731105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA LANE WATTS LPC

Provider Business Mailing Address
First Line	:	505 UNIVERSITY DR E
Second Line	:	STE.501
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-5901
Country	:	US
Telephone Number	:	979-571-8857
Fax Number	:	979-314-9993

Provider Business Practice Location Address
First Line	:	505 UNIVERSITY DR E
Second Line	:	STE. 501
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-5901
Country	:	US
Telephone Number	:	979-571-8857
Fax Number	:	979-314-9993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	05/08/2012

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Directions to “ VANESSA LANE WATTS LPC” Practice Location

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