Provider Demographics
NPI:1689217929
Name:WATTS, BETHANY BROOKE (BA)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:BROOKE
Last Name:WATTS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 NW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1712
Mailing Address - Country:US
Mailing Address - Phone:580-483-4100
Mailing Address - Fax:
Practice Address - Street 1:2304 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-1712
Practice Address - Country:US
Practice Address - Phone:580-483-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator