Provider Demographics
NPI:1902937451
Name:WATERS, KATHYE J (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHYE
Middle Name:J
Last Name:WATERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1512
Mailing Address - Country:US
Mailing Address - Phone:574-968-9660
Mailing Address - Fax:574-246-0171
Practice Address - Street 1:1411 LINCOLNWAY W
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1626
Practice Address - Country:US
Practice Address - Phone:574-256-2255
Practice Address - Fax:574-246-0171
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001162A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health