MEDICARE: DR. DANELLE J STEVENS-WATKINS PH.D.

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	:	1700210036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANELLE J STEVENS-WATKINS PH.D.

Provider Business Mailing Address
First Line	:	2220 EXECUTIVE DR STE 103
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4871
Country	:	US
Telephone Number	:	859-519-9017
Fax Number	:	502-614-6913

Provider Business Practice Location Address
First Line	:	2220 EXECUTIVE DR STE 103
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4871
Country	:	US
Telephone Number	:	859-519-9017
Fax Number	:	502-614-6913

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

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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