Provider Demographics
NPI:1164731105
Name:WATTS, VANESSA LANE (LPC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LANE
Last Name:WATTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 UNIVERSITY DR E
Mailing Address - Street 2:STE.501
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-5901
Mailing Address - Country:US
Mailing Address - Phone:979-571-8857
Mailing Address - Fax:979-314-9993
Practice Address - Street 1:505 UNIVERSITY DR E
Practice Address - Street 2:STE. 501
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-5901
Practice Address - Country:US
Practice Address - Phone:979-571-8857
Practice Address - Fax:979-314-9993
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65841101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX65841OtherTEXAS LICENSE