MEDICARE: ATHEA WATKINS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467999540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHEA WATKINS

Provider Business Mailing Address
First Line	:	841 IRVINE RD
Second Line	:
City	:	CLAY CITY
State	:	KY
Zip	:	40312
Country	:	US
Telephone Number	:	606-422-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	438 WASHINGTON ST
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-2048
Country	:	US
Telephone Number	:	859-253-1686
Fax Number	:

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

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	01/26/2017

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Directions to “ ATHEA WATKINS ” Practice Location

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