Provider Demographics
NPI:1427449974
Name:WATSON, CARRIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4077
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-4077
Mailing Address - Country:US
Mailing Address - Phone:719-963-5744
Mailing Address - Fax:719-309-1323
Practice Address - Street 1:400 W MIDLAND AVE
Practice Address - Street 2:SUITE 160 A&B
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3144
Practice Address - Country:US
Practice Address - Phone:719-963-5744
Practice Address - Fax:719-309-1323
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.8139101YM0800X
COLPC.0012495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health