Provider Demographics
NPI:1891478947
Name:WATKINS, KARLI GRACE (LMSW)
Entity Type:Individual
Prefix:
First Name:KARLI
Middle Name:GRACE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KARLI
Other - Middle Name:GRACE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3470 E ROUTE 66 STE 101
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-4059
Mailing Address - Country:US
Mailing Address - Phone:928-864-7199
Mailing Address - Fax:
Practice Address - Street 1:3470 E ROUTE 66 STE 101
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-4059
Practice Address - Country:US
Practice Address - Phone:928-864-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116745104100000X
AZLMSW-08115T1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker