Provider Demographics
NPI:1942329065
Name:WATSON, RAYMOND JOHN (D MIN, LPC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOHN
Last Name:WATSON
Suffix:
Gender:M
Credentials:D MIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 BLUE SPRUCE DR
Mailing Address - Street 2:STE 208
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-5415
Mailing Address - Country:US
Mailing Address - Phone:970-495-0300
Mailing Address - Fax:
Practice Address - Street 1:4674 SNOW MESA DR
Practice Address - Street 2:#140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8615
Practice Address - Country:US
Practice Address - Phone:970-482-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional