Healthcare Provider Details

I. General information

NPI: 1104738186
Provider Name (Legal Business Name): AKEEM WATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SAN PEDRO DR NE
ALBUQUERQUE NM
87108-1848
US

IV. Provider business mailing address

PO BOX 2853
WINDOW ROCK AZ
86515-2853
US

V. Phone/Fax

Practice location:
  • Phone: 505-206-0288
  • Fax:
Mailing address:
  • Phone: 505-422-3892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0664
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: