Healthcare Provider Details

I. General information

NPI: 1922031053
Provider Name (Legal Business Name): DANIELE M WATSON M.ED., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W APACHE ST
FARMINGTON NM
87401-5835
US

IV. Provider business mailing address

4 ROAD 6054
FARMINGTON NM
87401-9610
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-5321
  • Fax: 505-325-6453
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19389
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0093451
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: