MEDICARE: TAREVA WATTS LLMSW

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	101YP2500X	Professional Counselor	6851107896	MI

General Provider Information

NPI Number	:	1386315349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAREVA WATTS LLMSW

Provider Business Mailing Address
First Line	:	503 MALL CT # 247
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-5200
Country	:	US
Telephone Number	:	517-803-9326
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 OKEMOS RD
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-3287
Country	:	US
Telephone Number	:	517-803-9326
Fax Number	:

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

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	09/21/2021

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