Healthcare Provider Details

I. General information

NPI: 1144767252
Provider Name (Legal Business Name): PARRIS WATSON MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S MCCLINTOCK DR STE 105
TEMPE AZ
85282-2692
US

IV. Provider business mailing address

1300 W WARNER RD APT 1058
GILBERT AZ
85233-7027
US

V. Phone/Fax

Practice location:
  • Phone: 480-804-0326
  • Fax: 480-804-0083
Mailing address:
  • Phone: 614-373-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-18030
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: