Provider Demographics
NPI:1720475486
Name:WATT, LYVON
Entity Type:Individual
Prefix:
First Name:LYVON
Middle Name:
Last Name:WATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 A ST NE STE 9
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-1612
Mailing Address - Country:US
Mailing Address - Phone:812-847-7005
Mailing Address - Fax:812-847-5305
Practice Address - Street 1:1600 A ST NE STE 9
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-1612
Practice Address - Country:US
Practice Address - Phone:812-847-7005
Practice Address - Fax:812-847-5309
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000548A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical