Provider Demographics
NPI:1114663622
Name:WATSON, CRAIG (QMHA-I)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:QMHA-I
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:
Other - Last Name:O'MEARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA-R
Mailing Address - Street 1:2073 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3413
Mailing Address - Country:US
Mailing Address - Phone:541-682-3550
Mailing Address - Fax:
Practice Address - Street 1:2411 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5824
Practice Address - Country:US
Practice Address - Phone:541-682-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-08
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21-QMHA-I-003238106S00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician