MEDICARE: MRS. BECKY H WATSON 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	101YP2500X	Professional Counselor	LPC004707	GA

General Provider Information

NPI Number	:	1902088875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BECKY H WATSON LPC

Provider Business Mailing Address
First Line	:	6385 TRUDY DR
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-2622
Country	:	US
Telephone Number	:	404-597-3764
Fax Number	:	678-349-0633

Provider Business Practice Location Address
First Line	:	5415 THOMPSON MILL RD
Second Line	:
City	:	HOSCHTON
State	:	GA
Zip	:	30548-4038
Country	:	US
Telephone Number	:	404-597-3764
Fax Number	:	678-349-0633

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

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	11/12/2008

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