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Individual

DR. NICHOLAS WATTERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
1002 N MULBERRY ST STE 100, ELIZABETHTOWN, KY 42701-2037
(270) 401-4107
(270) 209-0872
Mailing address
216 LA FONTENAY CT, LOUISVILLE, KY 40223-3002
(270) 401-4107
(270) 209-0872

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1492
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11574941
CAQH
05
7100266120
KY
Enumeration date
05/25/2006
Last updated
09/17/2024
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