Dominque Latreace Wathan, CMII, BHWC

NPI #1992349427 in Shawnee, Oklahoma

Provider Information

NPI Number: 1992349427
Entity Type: Individual
Name: Dominque Latreace Wathan, CMII, BHWC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Case Manager/Care Coordinator
Credential: CMII, BHWC
Enumeration Date: Oct 28, 2019
Last Updated: Mar 4, 2025

Practice Location

Address: 111 W. 1ST ST
City: Shawnee
State: Oklahoma
ZIP Code: 74804-2202
Phone: (405) 273-1170

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X
Case Manager/Care Coordinator	171M00000X	Primary

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