Provider Demographics
NPI:1215136973
Name:WATTS, MURIEL Z (LCPC)
Entity type:Individual
Prefix:MS
First Name:MURIEL
Middle Name:Z
Last Name:WATTS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:MURIEL
Other - Middle Name:Z
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:10111 S KING DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2111
Mailing Address - Country:US
Mailing Address - Phone:773-928-5868
Mailing Address - Fax:
Practice Address - Street 1:10111 S KING DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2111
Practice Address - Country:US
Practice Address - Phone:773-928-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional