Provider Demographics
NPI:1346424314
Name:WATTS, ROXANNE JEANETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:JEANETTE
Last Name:WATTS
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 1:63051 MOREL LN
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:MI
Mailing Address - Zip Code:49061-8767
Mailing Address - Country:US
Mailing Address - Phone:574-370-7934
Mailing Address - Fax:
Practice Address - Street 1:3221 HOMER AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-2659
Practice Address - Country:US
Practice Address - Phone:574-370-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001633A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor