Healthcare Provider Details

I. General information

NPI: 1801342472
Provider Name (Legal Business Name): CYNTHIA WATSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 S. PRAIRIE AVENUE
PUEBLO CO
81005
US

IV. Provider business mailing address

109 LATIGO LN STE G
CANON CITY CO
81212-8113
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-5070
  • Fax: 719-896-2874
Mailing address:
  • Phone: 719-275-9799
  • Fax: 719-896-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNLC.0106660
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: