Provider Demographics
NPI:1184202715
Name:WATSON, ANTWON M
Entity Type:Individual
Prefix:
First Name:ANTWON
Middle Name:M
Last Name:WATSON
Suffix:
Gender:M
Credentials:
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 440134
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80044-0134
Mailing Address - Country:US
Mailing Address - Phone:720-687-8551
Mailing Address - Fax:
Practice Address - Street 1:325 E 18TH AVE APT 106
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1231
Practice Address - Country:US
Practice Address - Phone:720-687-8551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician