Individual
WATT OSAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1700 W BROADWAY ST, MUSKOGEE, OK 74401-3340
(918) 681-4201
Mailing address
PO BOX 77, WELLING, OK 74471-0077
(918) 431-9976
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3803
OK
Other
Enumeration date
04/16/2007
Last updated
10/05/2012
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