MEDICARE: KENNETH A WATKINS LCSW

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	1041C0700X	Clinical Social Worker	11476	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548262405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH A WATKINS LCSW

Provider Business Mailing Address
First Line	:	3010 CONWAY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2610
Country	:	US
Telephone Number	:	281-831-3602
Fax Number	:	281-362-7454

Provider Business Practice Location Address
First Line	:	1210 HAMBLEN RD
Second Line	:	SUITE 600
City	:	HUMBLE
State	:	TX
Zip	:	77339-4047
Country	:	US
Telephone Number	:	281-358-2221
Fax Number	:	281-358-2333

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/22/2016

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Directions to “ KENNETH A WATKINS LCSW” Practice Location

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