MEDICARE: CARRIE WATSON MA, 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
1	101YM0800X	Mental Health Counselor	NLC.8139	CO
2	101YP2500X	Professional Counselor	LPC.0012495	CO

General Provider Information

NPI Number	:	1427449974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE WATSON MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 4077
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80866-4077
Country	:	US
Telephone Number	:	719-963-5744
Fax Number	:	719-309-1323

Provider Business Practice Location Address
First Line	:	400 W MIDLAND AVE
Second Line	:	SUITE 160 A&B
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-3144
Country	:	US
Telephone Number	:	719-963-5744
Fax Number	:	719-309-1323

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

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	12/12/2016

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