MEDICARE: KAREN THERESA WATKINS L.C.P.C.

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	180-000944	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180-000944	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1578668521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN THERESA WATKINS L.C.P.C.

Provider Business Mailing Address
First Line	:	8100 WOODGLEN LN
Second Line	:	#108
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-4550
Country	:	US
Telephone Number	:	630-740-5351
Fax Number	:	630-985-6527

Provider Business Practice Location Address
First Line	:	346 TAFT AVE
Second Line	:	SUITE 030
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-6296
Country	:	US
Telephone Number	:	630-740-5351
Fax Number	:	630-985-6527

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	05/03/2008

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