Healthcare Provider Details

I. General information

NPI: 1497207823
Provider Name (Legal Business Name): ASHLEE WATSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 N CHARLES G SEIVERS BLVD SUITE 101
CLINTON TN
37716-3944
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY DEPARTMENT 100
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-934-6150
  • Fax: 865-342-0150
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10132
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6548
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: