Provider Demographics
NPI:1285273045
Name:WATSON, JERRY (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:WATSON
Suffix:
Gender:
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 EVELYN LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7168
Mailing Address - Country:US
Mailing Address - Phone:601-953-5515
Mailing Address - Fax:
Practice Address - Street 1:8566 CORDES CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-3317
Practice Address - Country:US
Practice Address - Phone:866-977-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical