Provider Demographics
NPI:1689710998
Name:WATSON, JULIE A (LPCC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16496
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87191-6496
Mailing Address - Country:US
Mailing Address - Phone:505-323-4447
Mailing Address - Fax:505-323-5075
Practice Address - Street 1:11930 MENAUL BLVD NE
Practice Address - Street 2:SUITE 102A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2478
Practice Address - Country:US
Practice Address - Phone:505-323-4447
Practice Address - Fax:505-323-5075
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23823399Medicaid