Provider Demographics
NPI:1730841339
Name:WATTREE, CECIL ELLIOTT JR (LSCSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:CECIL
Middle Name:ELLIOTT
Last Name:WATTREE
Suffix:JR
Gender:M
Credentials:LSCSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-1639
Mailing Address - Country:US
Mailing Address - Phone:816-601-9910
Mailing Address - Fax:
Practice Address - Street 1:9801 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-1639
Practice Address - Country:US
Practice Address - Phone:816-601-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS054881041C0700X
MO20210124251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical