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General NPI Number Information
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NPI Number | 1710485354
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Entity Type | Individual
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Provider Name | JACOB RAY WATSON
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Gender | Male
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 9274 INGLETON
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City | SAN ANTONIO
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State | TX
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Zip | 78245-1659
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Country | US
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Telephone | 210-672-0564
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Fax |
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Provider Business Mailing Address
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Address Line | 14317 POTRANCO ROARD SUITE 205, #327
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City | SAN ANTONIO
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State | TX
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Zip | 78253
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Country | US
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Telephone | 210-672-0564
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-17-36085
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-42381
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License Number State | TX
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