Provider Demographics
NPI:1275709891
Name:KAREN T. WATKINS & ASSOCIATES INC.
Entity Type:Organization
Organization Name:KAREN T. WATKINS & ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-740-5351
Mailing Address - Street 1:8100 WOODGLEN LN
Mailing Address - Street 2:UNIT 108
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4550
Mailing Address - Country:US
Mailing Address - Phone:630-740-5351
Mailing Address - Fax:630-985-6527
Practice Address - Street 1:346 TAFT AVE
Practice Address - Street 2:SUITE 030
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6296
Practice Address - Country:US
Practice Address - Phone:630-740-5351
Practice Address - Fax:630-985-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-03
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000944251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180-000944OtherSTATE LICENSE