Provider Demographics
NPI:1144708009
Name:WATTERS, MARIA (PHD, CRC, LCMHC, LPC)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:WATTERS
Suffix:
Gender:F
Credentials:PHD, CRC, LCMHC, LPC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRC
Mailing Address - Street 1:6796 NE BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6509
Mailing Address - Country:US
Mailing Address - Phone:801-885-7371
Mailing Address - Fax:
Practice Address - Street 1:4660 NE BELKNAP CT STE 119
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8402
Practice Address - Country:US
Practice Address - Phone:801-885-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4950101YM0800X, 101Y00000X
UT8935496-6004-2018091101YM0800X
00116673225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor