Provider Demographics
NPI:1104028133
Name:WATTS, VIRGINIA (MED, LCPC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:MED, LCPC
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 1377
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-1377
Mailing Address - Country:US
Mailing Address - Phone:406-388-7174
Mailing Address - Fax:406-388-4958
Practice Address - Street 1:129 VILLAGE DR STE 303
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9618
Practice Address - Country:US
Practice Address - Phone:406-388-7174
Practice Address - Fax:406-388-4958
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT597 LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0254796Medicaid