Provider Demographics
NPI:1205508561
Name:WATSON, MELINDA
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
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 1:2240 N HWY 89 STE C
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84404-2824
Mailing Address - Country:US
Mailing Address - Phone:877-393-6232
Mailing Address - Fax:
Practice Address - Street 1:2240 N HWY 89 STE C
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:UT
Practice Address - Zip Code:84404-2824
Practice Address - Country:US
Practice Address - Phone:877-393-6232
Practice Address - Fax:877-393-6232
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor