Healthcare Provider Details

I. General information

NPI: 1679428825
Provider Name (Legal Business Name): ALICE WATSON THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 N 115TH ST
OMAHA NE
68154-2558
US

IV. Provider business mailing address

138 HAPPY HOLLOW BLVD
COUNCIL BLUFFS IA
51503-1555
US

V. Phone/Fax

Practice location:
  • Phone: 308-627-1206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALICE WATSON
Title or Position: PLMHP
Credential:
Phone: 308-627-1206