Provider Demographics
NPI:1639425747
Name:WATSON, GARY W (MSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:W
Last Name:WATSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 SPAULDING AVE. STE D.
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301
Mailing Address - Country:US
Mailing Address - Phone:616-914-9874
Mailing Address - Fax:616-825-6007
Practice Address - Street 1:975 SPAULDING AVE STE D.
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301
Practice Address - Country:US
Practice Address - Phone:616-914-9874
Practice Address - Fax:616-825-6007
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010882181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical