Individual
MS. MARY ROSE WATTIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHP
Contact information
Practice address
501 E JACKSON ST, RANDOLPH, NE 68771-2519
(402) 337-1276
Mailing address
501 E JACKSON ST, RANDOLPH, NE 68771-2519
(402) 337-1276
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
P-785
NE
101YM0800X
Mental Health Counselor
Primary
3156
NE
101YP2500X
Professional Counselor
1638
NE
146N00000X
Basic Emergency Medical Technician
8600
NE
Other
Enumeration date
11/05/2011
Last updated
11/05/2011
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