Provider Demographics
NPI:1285425520
Name:WATSON, JOELLEN (PHD , LICSW)
Entity type:Individual
Prefix:DR
First Name:JOELLEN
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD , LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11956 W FAIRVIEW AVE APT J102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-8088
Mailing Address - Country:US
Mailing Address - Phone:206-715-2733
Mailing Address - Fax:
Practice Address - Street 1:11956 W FAIRVIEW AVE APT J102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-8088
Practice Address - Country:US
Practice Address - Phone:206-715-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00008179101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor