Provider Demographics
NPI:1700251386
Name:WATTS, JENNIFER JEAN (LLPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:WATTS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11638 CHASE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEBBERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48892-9522
Mailing Address - Country:US
Mailing Address - Phone:517-518-2503
Mailing Address - Fax:
Practice Address - Street 1:8123 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9464
Practice Address - Country:US
Practice Address - Phone:517-518-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health