Healthcare Provider Details

I. General information

NPI: 1841117405
Provider Name (Legal Business Name): CHRISTIAN SHEPARD WATSON CDP-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 E FOURTH PLAIN BLVD STE 101
VANCOUVER WA
98661-7662
US

IV. Provider business mailing address

8444 N 90TH ST STE 100
SCOTTSDALE AZ
85258-4437
US

V. Phone/Fax

Practice location:
  • Phone: 425-683-0800
  • Fax:
Mailing address:
  • Phone: 602-248-8886
  • Fax: 602-854-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.70106735
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: