Provider Demographics
NPI:1477681245
Name:WATSON, CURTIS WAYNE (LCSW MSW)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:WAYNE
Last Name:WATSON
Suffix:
Gender:M
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W CENTER ST APT 291
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2577
Mailing Address - Country:US
Mailing Address - Phone:801-721-0473
Mailing Address - Fax:
Practice Address - Street 1:55 W CENTER ST APT 291
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2577
Practice Address - Country:US
Practice Address - Phone:801-721-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health