Provider Demographics
NPI:1720031008
Name:WATTS, KEITH D (LCSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:WATTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 NAAB RD
Mailing Address - Street 2:103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5925
Mailing Address - Country:US
Mailing Address - Phone:317-988-1600
Mailing Address - Fax:317-988-1617
Practice Address - Street 1:8330 NAAB RD
Practice Address - Street 2:103
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5925
Practice Address - Country:US
Practice Address - Phone:317-988-1600
Practice Address - Fax:317-988-1617
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003668A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN209610XMedicare ID - Type Unspecified