Provider Demographics
NPI:1992920938
Name:WATTS, ISAAC GORDON (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:GORDON
Last Name:WATTS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 FULTON ST E STE 209E
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3200
Mailing Address - Country:US
Mailing Address - Phone:616-279-9978
Mailing Address - Fax:616-724-4331
Practice Address - Street 1:233 FULTON ST E STE 209E
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3200
Practice Address - Country:US
Practice Address - Phone:616-279-9978
Practice Address - Fax:616-724-4331
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional