Provider Demographics
NPI:1639541238
Name:WATT, DEBORAH (MFTI, PCCI)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WATT
Suffix:
Gender:F
Credentials:MFTI, PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 GLENNEYRE ST.
Mailing Address - Street 2:SUITE Q
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92675
Mailing Address - Country:US
Mailing Address - Phone:949-933-1242
Mailing Address - Fax:
Practice Address - Street 1:920 GLENNEYRE ST
Practice Address - Street 2:SUITE Q
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2740
Practice Address - Country:US
Practice Address - Phone:949-933-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF84984101YM0800X
CAPCCI1962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional