Individual
MR. GARY WAYNE WATULAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
0470000240
VT
103TB0200X
Cognitive & Behavioral Psychologist
0470000240
VT
103TC0700X
Clinical Psychologist
Primary
0470000240
VT
103TC1900X
Counseling Psychologist
0470000240
VT
103TF0000X
Family Psychologist
0470000240
VT
103TP2701X
Group Psychotherapy Psychologist
0470000240
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006590
—
VT
01
—
11326073
CAQH
—
01
—
331856
MHN
VT
01
—
51742
CIGNA
—
01
—
6590
BCBS
VT
01
—
691411
MVP
VT
Enumeration date
08/10/2006
Last updated
09/11/2025
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