Provider Demographics
NPI:1194946269
Name:WATHEN, STEPHEN H (LPC, LCDC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:H
Last Name:WATHEN
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 470 BOX 283
Mailing Address - Street 2:
Mailing Address - City:HANAU
Mailing Address - State:APO AE
Mailing Address - Zip Code:09165
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 470 BOX 283
Practice Address - Street 2:
Practice Address - City:HANAU
Practice Address - State:APO AE
Practice Address - Zip Code:09165
Practice Address - Country:DE
Practice Address - Phone:322-8911
Practice Address - Fax:322354
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2105101YA0400X
TX14833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health