Provider Demographics
NPI:1003154170
Name:WAATSA, ROBERT K (LPCC, LADAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:K
Last Name:WAATSA
Suffix:
Gender:M
Credentials:LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0339
Mailing Address - Country:US
Mailing Address - Phone:505-782-5719
Mailing Address - Fax:505-782-5735
Practice Address - Street 1:20 RT 301 NORTH
Practice Address - Street 2:
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327
Practice Address - Country:US
Practice Address - Phone:505-782-5719
Practice Address - Fax:505-782-5735
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0159721101YA0400X
NM0156201101YM0800X
NMCCMH0208201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)