Provider Demographics
NPI:1700921186
Name:WATABE, JOLEENE LOUISE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JOLEENE
Middle Name:LOUISE
Last Name:WATABE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JOLEENE
Other - Middle Name:LOUISE
Other - Last Name:TOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6183 ENKE CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-9517
Mailing Address - Country:US
Mailing Address - Phone:513-850-4824
Mailing Address - Fax:
Practice Address - Street 1:715 S PLUM ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1631
Practice Address - Country:US
Practice Address - Phone:937-644-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
OHC.0700189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator