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NPI Code Detail

MEDICARE: ROXANNE ELIZABETH WATSON MS, LPC

MEDICARE: ROXANNE ELIZABETH WATSON MS, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor5236OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063748689
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROXANNE ELIZABETH WATSON MS, LPC
Provider Business Mailing Address
First Line : 709 S RAILROAD ST
Second Line :
City : POTEAU
State : OK
Zip : 74953-4713
Country : US
Telephone Number : 918-721-4191
Fax Number :
Provider Business Practice Location Address
First Line : 804 S BROADWAY ST
Second Line :
City : POTEAU
State : OK
Zip : 74953-3834
Country : US
Telephone Number : 918-647-9629
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2009
Last Update Date : 07/17/2014

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