Provider Demographics
NPI:1043590094
Name:WATSON, JEFFERY (EDD, MS, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:EDD, MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-8050
Mailing Address - Country:US
Mailing Address - Phone:321-269-4590
Mailing Address - Fax:
Practice Address - Street 1:701 5TH AVE STE 42
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-7097
Practice Address - Country:US
Practice Address - Phone:206-395-6088
Practice Address - Fax:206-350-9033
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60622680Medicaid