Provider Demographics
NPI:1336357953
Name:WATSON, PATRICIA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 ROUGH DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-6832
Mailing Address - Country:US
Mailing Address - Phone:248-347-4385
Mailing Address - Fax:928-237-5679
Practice Address - Street 1:948 ROUGH DIAMOND DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-6832
Practice Address - Country:US
Practice Address - Phone:248-347-4385
Practice Address - Fax:928-237-5679
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4314103TC0700X
MI6301002254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical