MEDICARE: MR. JERMAINE ANDRE WATSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2017034860	MO

General Provider Information

NPI Number	:	1285145748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERMAINE ANDRE WATSON LPC

Provider Business Mailing Address
First Line	:	546 CHAPEL CROSS DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-1674
Country	:	US
Telephone Number	:	314-749-0760
Fax Number	:	636-333-0029

Provider Business Practice Location Address
First Line	:	111 W PORT PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3011
Country	:	US
Telephone Number	:	314-749-0760
Fax Number	:	636-333-0029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	04/07/2026

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