Provider Demographics
NPI:1407985229
Name:WATSON, TERRILL PAUL (LPC)
Entity Type:Individual
Prefix:MR
First Name:TERRILL
Middle Name:PAUL
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 1:4110 HOBBY HORSE LN
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-9361
Mailing Address - Country:US
Mailing Address - Phone:918-724-4779
Mailing Address - Fax:918-396-7929
Practice Address - Street 1:4110 HOBBY HORSE LN
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-9361
Practice Address - Country:US
Practice Address - Phone:918-724-4779
Practice Address - Fax:918-396-7929
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2020-02-11
Deactivation Date:2019-01-10
Deactivation Code:
Reactivation Date:2020-02-11
Provider Licenses
StateLicense IDTaxonomies
OK1472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional