Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0159721 | NM |
N | 101YM0800X | Mental Health Counselor | 0156201 | NM |
Y | 101YM0800X | Mental Health Counselor | CCMH0208201 | NM |
NPI | 1003154170 |
---|---|
Provider Name | Mr. Robert K. Waatsa |
First Address | Zuni, NM 87327-0339 |
Second Address | Zuni, NM 87327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2013 |
Last Update Date | 17/02/2021 |