Provider Demographics
NPI:1134382443
Name:WATSON, GERRY LYNN (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:GERRY
Middle Name:LYNN
Last Name:WATSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 HANOVER ST APT I2
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1731
Mailing Address - Country:US
Mailing Address - Phone:615-692-9273
Mailing Address - Fax:
Practice Address - Street 1:1619 HANOVER ST APT I2
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1731
Practice Address - Country:US
Practice Address - Phone:615-692-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1032OtherLICENSE CLINICAL SOCIAL WORKER