Provider Demographics
NPI:1023700481
Name:WATTERS-MILLER, BETHANY J
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:J
Last Name:WATTERS-MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:J
Other - Last Name:WATTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAC-IT
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:BOWLER
Mailing Address - State:WI
Mailing Address - Zip Code:54416-0086
Mailing Address - Country:US
Mailing Address - Phone:715-793-0531
Mailing Address - Fax:
Practice Address - Street 1:W12802 COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416-9551
Practice Address - Country:US
Practice Address - Phone:175-793-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19780-130101YA0400X
WI7479-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)