Provider Demographics
NPI:1760498679
Name:WATSON, JEFFREY ALAN (MED, LCPC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:WATSON
Suffix:
Gender:M
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6565
Mailing Address - Country:US
Mailing Address - Phone:406-782-4778
Mailing Address - Fax:406-782-1318
Practice Address - Street 1:2510 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6565
Practice Address - Country:US
Practice Address - Phone:406-782-4778
Practice Address - Fax:406-782-1318
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0255323Medicaid