Provider Demographics
NPI:1952688962
Name:WATTIER, MARY ROSE (LMHP)
Entity Type:Individual
Prefix:MS
First Name:MARY ROSE
Middle Name:
Last Name:WATTIER
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NE
Mailing Address - Zip Code:68771-2519
Mailing Address - Country:US
Mailing Address - Phone:402-337-1276
Mailing Address - Fax:
Practice Address - Street 1:501 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NE
Practice Address - Zip Code:68771-2519
Practice Address - Country:US
Practice Address - Phone:402-337-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-785101YA0400X
NE3156101YM0800X
NE1638101YP2500X
NE8600146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic