Healthcare Provider Details

I. General information

NPI: 1346224227
Provider Name (Legal Business Name): MICHELLE LOUISE WATSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HARCOURT RD
INDIANAPOLIS IN
46260-2036
US

IV. Provider business mailing address

9588 VALPARAISO CT
INDIANAPOLIS IN
46268-1130
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001016A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: