Provider Demographics
NPI:1407122641
Name:WATERS, CHRISTOPHER ASHTON (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ASHTON
Last Name:WATERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4405
Mailing Address - Country:US
Mailing Address - Phone:208-890-8218
Mailing Address - Fax:208-378-1142
Practice Address - Street 1:3308 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4405
Practice Address - Country:US
Practice Address - Phone:208-890-8218
Practice Address - Fax:208-378-1142
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY 202655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical