Healthcare Provider Details

I. General information

NPI: 1396795613
Provider Name (Legal Business Name): PATTI RAE WATSON ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 W CALLE LAGO
TUCSON AZ
85704-3914
US

IV. Provider business mailing address

454 W CALLE LAGO
TUCSON AZ
85704-3914
US

V. Phone/Fax

Practice location:
  • Phone: 520-229-2012
  • Fax: 520-288-8222
Mailing address:
  • Phone: 520-229-2012
  • Fax: 520-288-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3298
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: