Provider Demographics
NPI:1437693645
Name:WATSON, JACQUELINE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 HAMBLETON DR
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-9744
Mailing Address - Country:US
Mailing Address - Phone:503-707-4795
Mailing Address - Fax:
Practice Address - Street 1:1966 HAMBLETON DR
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655-9744
Practice Address - Country:US
Practice Address - Phone:254-481-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist