Provider Demographics
NPI:1639676208
Name:WATERS, JOHN MITCHELL (PHD, LPC-MHSP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MITCHELL
Last Name:WATERS
Suffix:
Gender:M
Credentials:PHD, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 WELSENBORO CIR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3343
Mailing Address - Country:US
Mailing Address - Phone:423-443-5605
Mailing Address - Fax:
Practice Address - Street 1:1004 HICKORY HILL LN
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1930
Practice Address - Country:US
Practice Address - Phone:423-499-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional