Provider Demographics
NPI:1740416510
Name:WATTERS, CARRIE LYNN (MS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:WATTERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:WATTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:86129 GOSSLER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-9636
Mailing Address - Country:US
Mailing Address - Phone:541-228-0846
Mailing Address - Fax:
Practice Address - Street 1:260 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3247
Practice Address - Country:US
Practice Address - Phone:541-484-4428
Practice Address - Fax:541-484-7212
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional