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 1:1187 N WILLOW AVE STE 103-766
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4411
Mailing Address - Country:US
Mailing Address - Phone:801-980-0106
Mailing Address - Fax:
Practice Address - Street 1:1187 N WILLOW AVE STE 103-766
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4411
Practice Address - Country:US
Practice Address - Phone:801-980-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
CALPCC13242101YM0800X
UT11978832-6004101YM0800X
OHE.2001914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator