Provider Demographics
NPI:1265673800
Name:WATSON, JASON ELLIOT (LPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ELLIOT
Last Name:WATSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 EMBERCREST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5063
Mailing Address - Country:US
Mailing Address - Phone:214-213-6434
Mailing Address - Fax:972-775-3108
Practice Address - Street 1:107 E PALESTINE ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-2867
Practice Address - Country:US
Practice Address - Phone:214-213-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional