Individual
TRACY MONIQUE WATHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
(270) 234-8572
Mailing address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
(270) 234-8572
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
252190
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30605018
—
KY
Enumeration date
02/14/2007
Last updated
08/19/2016
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