Organization
NICK WATTERS, PSYD PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS WATTERS PSYD (CEO)
(270) 401-4107
Entity
Organization
Contact information
Practice address
240 W DIXIE AVE, SUITE 5-B, ELIZABETHTOWN, KY 42701-1586
(270) 401-4107
Mailing address
PO BOX 6278, ELIZABETHTOWN, KY 42702-6278
(270) 401-4107
(270) 209-0872
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
KY-1492
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30605018
—
KY
Enumeration date
02/20/2013
Last updated
07/07/2014
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