Provider Demographics
NPI:1710342951
Name:WATTS, TINA M (RBT)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:M
Last Name:WATTS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:HARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:11001 NW LEMA DR APT B
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3931
Mailing Address - Country:US
Mailing Address - Phone:417-850-1309
Mailing Address - Fax:
Practice Address - Street 1:14844 W 107TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4002
Practice Address - Country:US
Practice Address - Phone:720-319-7614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
RBT-17-33977106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator