Provider Demographics
NPI:1053478305
Name:WATKINS, JUDITH KATHLEEN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:KATHLEEN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 LAMPLIGHT CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2958
Mailing Address - Country:US
Mailing Address - Phone:925-932-2022
Mailing Address - Fax:
Practice Address - Street 1:919 VILLAGE CTR
Practice Address - Street 2:SUITE 5
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3598
Practice Address - Country:US
Practice Address - Phone:925-932-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30154106H00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA09000OtherMEDICAL