Provider Demographics
NPI:1609882257
Name:WATSON, CHERSTIE ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERSTIE
Middle Name:ANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31316 BRIDLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-4185
Mailing Address - Country:US
Mailing Address - Phone:210-313-5337
Mailing Address - Fax:
Practice Address - Street 1:31316 BRIDLEGATE DR
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-4185
Practice Address - Country:US
Practice Address - Phone:210-313-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150819401Medicaid