Provider Demographics
NPI:1720396328
Name:WATERS, CHRISTOPHER BROCK (LPC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BROCK
Last Name:WATERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FORSYTHE AVE
Mailing Address - Street 2:C/O GUIDANCE OFFICE
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4060
Mailing Address - Country:US
Mailing Address - Phone:318-323-2237
Mailing Address - Fax:318-323-1737
Practice Address - Street 1:600 FORSYTHE AVE
Practice Address - Street 2:C/O GUIDANCE OFFICE
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4060
Practice Address - Country:US
Practice Address - Phone:318-323-2237
Practice Address - Fax:318-323-1737
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional