Provider Demographics
NPI:1346399888
Name:WATSON, HOLBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:HOLBERT
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 N ROCK RUN DR
Mailing Address - Street 2:SUITE 22
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3153
Mailing Address - Country:US
Mailing Address - Phone:815-730-8900
Mailing Address - Fax:815-730-0988
Practice Address - Street 1:1520 N ROCK RUN DR
Practice Address - Street 2:SUITE 22
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-3153
Practice Address - Country:US
Practice Address - Phone:815-730-8900
Practice Address - Fax:815-730-0988
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health