Provider Demographics
NPI:1417090119
Name:WATSON, BETTY LOU (LMHC)
Entity Type:Individual
Prefix:
First Name:BETTY LOU
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 LAKE MEAD AVENUE
Mailing Address - Street 2:SUITE &03
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-646-0054
Mailing Address - Fax:904-646-0630
Practice Address - Street 1:11512 LAKE MEAD AVENUE
Practice Address - Street 2:SUITE &03
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-646-0054
Practice Address - Fax:904-646-0630
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health