Provider Demographics
NPI:1275619678
Name:WATSON, JOSHUA CHAD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:CHAD
Last Name:WATSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-1234
Mailing Address - Country:US
Mailing Address - Phone:601-553-9937
Mailing Address - Fax:
Practice Address - Street 1:2221 HWY 39 NORTH
Practice Address - Street 2:SUITE C
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-2636
Practice Address - Country:US
Practice Address - Phone:601-553-9937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1045101YP2500X
NC3860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional