Healthcare Provider Details

I. General information

NPI: 1013439819
Provider Name (Legal Business Name): TRAVIS L WATSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TURNSTONE DR
MORGANTOWN WV
26505-3869
US

IV. Provider business mailing address

40 TURNSTONE DR
MORGANTOWN WV
26505-3869
US

V. Phone/Fax

Practice location:
  • Phone: 724-825-5527
  • Fax:
Mailing address:
  • Phone: 724-825-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPC009369
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC009369
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: