Provider Demographics
NPI:1295254571
Name:WATTS, IAN COLE (LCSW)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:COLE
Last Name:WATTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4003
Mailing Address - Country:US
Mailing Address - Phone:806-438-8089
Mailing Address - Fax:806-500-2935
Practice Address - Street 1:4413 71ST ST STE G101
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2319
Practice Address - Country:US
Practice Address - Phone:806-412-4721
Practice Address - Fax:806-500-2935
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK84791041C0700X
TX634691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical