Provider Demographics
NPI:1891176889
Name:WATTERSON, MICHAEL (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WATTERSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S DUFFY RD
Mailing Address - Street 2:STE B
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2789
Mailing Address - Country:US
Mailing Address - Phone:724-256-9881
Mailing Address - Fax:724-256-9883
Practice Address - Street 1:205 S DUFFY RD
Practice Address - Street 2:STE B
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2789
Practice Address - Country:US
Practice Address - Phone:724-256-9881
Practice Address - Fax:724-256-9883
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007568101YP2500X
PAPS018295103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional