Isaac Gordon Watts, M.A., L.P.C.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401009315 Issued in MI

Practice address

233 Fulton St E Ste 209E
Grand Rapids, MI 49503-3200

Phone

(616) 279-9978

Fax

(616) 724-4331

NPI assigned

Apr 16, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Koinonia Professional Counseling Services LLC

  • Professional Counselor
  • Grand Rapids, MI
  • NPI 1780079210
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1992920938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 FULTON ST E STE 209E",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033200",
            "telephone_number": "616-279-9978",
            "fax_number": "616-724-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 FULTON ST E STE 209E",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033200",
            "telephone_number": "616-279-9978",
            "fax_number": "616-724-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTS",
        "first_name": "ISAAC",
        "middle_name": "GORDON",
        "name_prefix": "Mr.",
        "credential": "M.A., L.P.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401009315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaun Watson
• Stacey Watson, M.S.
• Wilbur K Watson III
• Marla Watts-Pacheco, BCBA, LBA
• Carolyn Watts, MD
• Elise Waugh
• Nicole Rae Waugh, LLMSW
• Trisha Marie Waun, LMSW, CAADC
• Way to Thrive
• Derek Lee Way

• Professional Counselor in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.