Provider Demographics
NPI:1063748689
Name:WATSON, ROXANNE ELIZABETH (MS, LPC)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:ELIZABETH
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-4713
Mailing Address - Country:US
Mailing Address - Phone:918-721-4191
Mailing Address - Fax:
Practice Address - Street 1:804 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-3834
Practice Address - Country:US
Practice Address - Phone:918-647-9629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK101YM0800Medicaid