Provider Demographics
NPI:1427557032
Name:JESSICA WATSON COUNSELING, LLC
Entity Type:Organization
Organization Name:JESSICA WATSON COUNSELING, LLC
Other - Org Name:JESSICA WATSON COUNSELING, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:SOCIAL WORKER CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-458-2401
Mailing Address - Street 1:1938 SARAH LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2084
Mailing Address - Country:US
Mailing Address - Phone:813-458-2401
Mailing Address - Fax:
Practice Address - Street 1:1200 W PLATT ST STE 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2136
Practice Address - Country:US
Practice Address - Phone:813-458-2401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW139671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty