Provider Demographics
NPI:1619477767
Name:WATSON, PHILIP
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 HIGH BLUFF DR STE 216
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2054
Mailing Address - Country:US
Mailing Address - Phone:760-635-3310
Mailing Address - Fax:760-230-9291
Practice Address - Street 1:12625 HIGH BLUFF DR STE 216
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2054
Practice Address - Country:US
Practice Address - Phone:760-635-3310
Practice Address - Fax:760-230-9291
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health