Provider Demographics
NPI:1932480654
Name:WATSON, CATHY ANN (MED, MHR)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:MED, MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 VANDIVER SW
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-9340
Mailing Address - Country:US
Mailing Address - Phone:405-326-5714
Mailing Address - Fax:405-265-0506
Practice Address - Street 1:3201 N MUSTANG RD
Practice Address - Street 2:UNIT A
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3399
Practice Address - Country:US
Practice Address - Phone:405-265-0098
Practice Address - Fax:400-526-5050
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional