Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003351529 |
---|---|
Provider Name | Misty Watts |
First Address | Klamath Falls, OR 97601-6418 |
Second Address | Klamath Falls, OR 97601-6418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2016 |
Last Update Date | 20/12/2016 |