Provider Demographics
NPI:1861273609
Name:WATT, LYDIA KATHERINE CRESSMAN
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:KATHERINE CRESSMAN
Last Name:WATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 NW 113TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2701
Mailing Address - Country:US
Mailing Address - Phone:405-312-5135
Mailing Address - Fax:
Practice Address - Street 1:7308 NW 113TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2701
Practice Address - Country:US
Practice Address - Phone:405-312-5135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health