MEDICARE: BECCA WATSON

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACB7610	CO

General Provider Information

NPI Number	:	1417052911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECCA WATSON

Provider Business Mailing Address
First Line	:	3000 S COLLEGE AVE
Second Line	:	SUITE 202
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2558
Country	:	US
Telephone Number	:	970-221-4057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 S COLLEGE AVE
Second Line	:	SUITE 202
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2558
Country	:	US
Telephone Number	:	970-221-4057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	10/09/2016

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