Provider Demographics
NPI:1174179279
Name:WATSON, CYRILLA (RBT)
Entity type:Individual
Prefix:
First Name:CYRILLA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 W CHERRY LN STE 1041
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1119
Mailing Address - Country:US
Mailing Address - Phone:208-921-8693
Mailing Address - Fax:208-416-6922
Practice Address - Street 1:3313 W CHERRY LN STE 1041
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1119
Practice Address - Country:US
Practice Address - Phone:208-921-8693
Practice Address - Fax:208-416-6922
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1-22-57850OtherBACB BOARD
WARBT-19-95584OtherBACB BOARD