Healthcare Provider Details

I. General information

NPI: 1689710998
Provider Name (Legal Business Name): JULIE A. WATSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11930 MENAUL BLVD NE SUITE 102A
ALBUQUERQUE NM
87112-2478
US

IV. Provider business mailing address

PO BOX 16496
ALBUQUERQUE NM
87191-6496
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-4447
  • Fax: 505-323-5075
Mailing address:
  • Phone: 505-323-4447
  • Fax: 505-323-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005683
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: