Provider Demographics
NPI:1043485857
Name:WATKINS, LORA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:LORA
Middle Name:J
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14217 S TEMPEST RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1873
Mailing Address - Country:US
Mailing Address - Phone:915-201-0621
Mailing Address - Fax:844-903-2824
Practice Address - Street 1:14217 S TEMPEST RIDGE CIR
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-1873
Practice Address - Country:US
Practice Address - Phone:152-010-6219
Practice Address - Fax:844-903-2824
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5208-C1041C0700X
COCSW.099265521041C0700X
TX585061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical