Provider Demographics
NPI:1346520343
Name:WATSON, DEAGAN DARYL (LMHC)
Entity Type:Individual
Prefix:
First Name:DEAGAN
Middle Name:DARYL
Last Name:WATSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 NW 89TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-3813
Mailing Address - Country:US
Mailing Address - Phone:352-494-6530
Mailing Address - Fax:352-265-5419
Practice Address - Street 1:4101 NW 89TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-3813
Practice Address - Country:US
Practice Address - Phone:352-494-6530
Practice Address - Fax:352-265-5419
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10234283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital