MEDICARE: VANESSA SENTHA WATTNEM LMFTA

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	106H00000X	Marriage & Family Therapist	205491	TX

General Provider Information

NPI Number	:	1235956319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA SENTHA WATTNEM LMFTA

Provider Business Mailing Address
First Line	:	23515 NE NOVELTY HILL RD STE B221
Second Line	:
City	:	REDMOND
State	:	WA
Zip	:	98053-1996
Country	:	US
Telephone Number	:	737-222-3366
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 DONORE PL APT 58
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2681
Country	:	US
Telephone Number	:	737-222-3366
Fax Number	:

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

Provider Enumeration Date	:	09/20/2024
Last Update Date	:	09/20/2024

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