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General NPI Number Information
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NPI Number | 1912483082
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Entity Type | Individual
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Provider Name | JORDAN WATSON LPC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1223
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Country | US
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Telephone | 314-328-0496
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Fax |
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Provider Business Mailing Address
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Address Line | 1534 SYCAMORE GLEN CT
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City | FLORISSANT
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State | MO
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Zip | 63031-1150
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Country | US
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Telephone | 770-778-7700
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2017022183
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License Number State | MO
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