Provider Demographics
NPI:1326385394
Name:WATT, CANDICE MARIE (MA ED)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:MARIE
Last Name:WATT
Suffix:
Gender:F
Credentials:MA ED
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 70
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:WY
Mailing Address - Zip Code:82730-0070
Mailing Address - Country:US
Mailing Address - Phone:307-746-8635
Mailing Address - Fax:
Practice Address - Street 1:420 DEANNE AVENUE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701
Practice Address - Country:US
Practice Address - Phone:307-746-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1003101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor