Provider Demographics
NPI:1053728386
Name:WATTS, TESSA (ACMHC)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711083
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-1083
Mailing Address - Country:US
Mailing Address - Phone:801-662-8050
Mailing Address - Fax:
Practice Address - Street 1:638 N 2400 W
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:84015-4819
Practice Address - Country:US
Practice Address - Phone:801-900-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8920668-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health