Provider Demographics
NPI:1407122641
Name:WATERS, CHRISTOPHER ASHTON (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ASHTON
Last Name:WATERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1666
Mailing Address - Country:US
Mailing Address - Phone:208-972-9988
Mailing Address - Fax:877-552-0981
Practice Address - Street 1:100 N HOWARD ST # 5684
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0508
Practice Address - Country:US
Practice Address - Phone:208-972-9988
Practice Address - Fax:877-552-0981
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY 202655103TC0700X
OR3094103TC0700X
WAPY60951973103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical