Provider Demographics
NPI:1154453421
Name:WATSON, HELENE T (MA)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:T
Last Name:WATSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 G ST STE 8
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2030
Mailing Address - Country:US
Mailing Address - Phone:719-221-6937
Mailing Address - Fax:
Practice Address - Street 1:123 G ST STE 8
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2030
Practice Address - Country:US
Practice Address - Phone:719-221-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00880841Medicaid