MEDICARE: DANELLE STEVENS-WATKINS PHD PLLC

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	103TC1900X	Counseling Psychologist	1587	KY

General Provider Information

NPI Number	:	1477870079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANELLE STEVENS-WATKINS PHD PLLC

Provider Business Mailing Address
First Line	:	6511 GLENRIDGE PARK PLACE STE 5
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-3452
Country	:	US
Telephone Number	:	502-614-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6511 GLENRIDGE PARK PLACE STE 5
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-3452
Country	:	US
Telephone Number	:	502-614-7600
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. DANELLE STEVENS-WATKINS
Credential	:	PH.D.
Telephone Number	:	502-614-7600

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	04/23/2010

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