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General NPI Number Information
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NPI Number | 1821221177
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Entity Type | Individual
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Provider Name | THEOPHLIUS WATSON III LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 03/16/2025
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Provider Practice Location Address
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Address Line | 1061 HESSELRIDGE
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City | HEWITT
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State | TX
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Zip | 76643-4401
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Country | US
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Telephone | 505-227-4338
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 HESSELRIDGE
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City | HEWITT
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State | TX
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Zip | 76643-4401
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Country | US
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Telephone | 505-227-4338
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-08252
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 108525
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | C-08252
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 108525
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License Number State | TX
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