Provider Demographics
NPI:1982909651
Name:WATT, VICKI J
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:J
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:RR 5 BOX 152
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-9504
Mailing Address - Country:US
Mailing Address - Phone:918-339-5800
Mailing Address - Fax:918-339-5820
Practice Address - Street 1:HC 67 BOX 5
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:OK
Practice Address - Zip Code:74425-9700
Practice Address - Country:US
Practice Address - Phone:918-339-5800
Practice Address - Fax:918-338-5820
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)