Provider Demographics
NPI:1285145748
Name:WATSON, JERMAINE ANDRE (LPC)
Entity type:Individual
Prefix:MR
First Name:JERMAINE
Middle Name:ANDRE
Last Name:WATSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 CHAPEL CROSS DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1674
Mailing Address - Country:US
Mailing Address - Phone:314-749-0760
Mailing Address - Fax:314-731-4433
Practice Address - Street 1:737 DUNN RD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1740
Practice Address - Country:US
Practice Address - Phone:314-731-2433
Practice Address - Fax:314-731-4433
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017034860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional