Provider Demographics
NPI:1821314253
Name:WATSON, MICHELLE JEAN (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JEAN
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9288 SW 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9604
Mailing Address - Country:US
Mailing Address - Phone:503-244-6160
Mailing Address - Fax:503-244-6160
Practice Address - Street 1:9288 SW 77TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-9604
Practice Address - Country:US
Practice Address - Phone:503-244-6160
Practice Address - Fax:503-244-6160
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1409101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional