Provider Demographics
NPI:1861896433
Name:WATSON, PAULA M (LPC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 SW COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1099
Mailing Address - Country:US
Mailing Address - Phone:541-447-0707
Mailing Address - Fax:
Practice Address - Street 1:910 SW HIGHWAY 97
Practice Address - Street 2:SUITE 101
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9247
Practice Address - Country:US
Practice Address - Phone:541-475-7800
Practice Address - Fax:541-475-6600
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional