Provider Demographics
NPI:1861787277
Name:WATSON, JEROME EVERETTE SR (LMFT)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:EVERETTE
Last Name:WATSON
Suffix:SR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16333 GREEN TREE BLVD UNIT 2673
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-7108
Mailing Address - Country:US
Mailing Address - Phone:909-915-4998
Mailing Address - Fax:
Practice Address - Street 1:12180 RIDGECREST RD STE 402A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5902
Practice Address - Country:US
Practice Address - Phone:760-881-3558
Practice Address - Fax:760-881-3457
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist