Provider Demographics
NPI:1477860849
Name:WATTS, CONNIE A (MS, LCMFT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:A
Last Name:WATTS
Suffix:
Gender:F
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MEDICINE LODGE
Mailing Address - State:KS
Mailing Address - Zip Code:67104-1418
Mailing Address - Country:US
Mailing Address - Phone:620-213-1016
Mailing Address - Fax:
Practice Address - Street 1:108 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:MEDICINE LODGE
Practice Address - State:KS
Practice Address - Zip Code:67104-1306
Practice Address - Country:US
Practice Address - Phone:620-213-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist