Provider Demographics
NPI:1417112285
Name:WATSON, MARK LANDON (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LANDON
Last Name:WATSON
Suffix:
Gender:M
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 1:900 E CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-6502
Mailing Address - Country:US
Mailing Address - Phone:731-423-3653
Mailing Address - Fax:731-422-2820
Practice Address - Street 1:900 E CHESTER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-6502
Practice Address - Country:US
Practice Address - Phone:731-423-3653
Practice Address - Fax:731-422-2820
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional