Provider Demographics
NPI:1811374663
Name:WATSON, CINDY KAY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:KAY
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 LAMBERT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-9549
Mailing Address - Country:US
Mailing Address - Phone:509-775-0483
Mailing Address - Fax:509-779-6067
Practice Address - Street 1:56 N CLARK AVE
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-5024
Practice Address - Country:US
Practice Address - Phone:509-795-2887
Practice Address - Fax:097-796-0675
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60583830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health