MEDICARE: CHA'RON KEONTYA WATT WINDER

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	101YM0800X	Mental Health Counselor		MS

General Provider Information

NPI Number	:	1568320737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHA'RON KEONTYA WATT WINDER

Provider Business Mailing Address
First Line	:	1867 CRANE RIDGE DR STE 150C
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4982
Country	:	US
Telephone Number	:	769-251-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 W REED RD STE A-1
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-6967
Country	:	US
Telephone Number	:	662-702-5108
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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