Provider Demographics
NPI:1730862582
Name:WATTERSON, ROBERT (MPH, MA, LPCC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WATTERSON
Suffix:
Gender:M
Credentials:MPH, MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 WASHINGTON AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1186
Mailing Address - Country:US
Mailing Address - Phone:720-805-4639
Mailing Address - Fax:
Practice Address - Street 1:1204 WASHINGTON AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1186
Practice Address - Country:US
Practice Address - Phone:720-805-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health