Provider Demographics
NPI:1669710075
Name:WATSON, AMIE SCOTT (LMFT)
Entity type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:SCOTT
Last Name:WATSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 CORINNE ST
Mailing Address - Street 2:A2
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3831
Mailing Address - Country:US
Mailing Address - Phone:601-268-8796
Mailing Address - Fax:601-336-7563
Practice Address - Street 1:607 CORINNE ST
Practice Address - Street 2:A2
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3831
Practice Address - Country:US
Practice Address - Phone:601-268-8796
Practice Address - Fax:601-336-7563
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTO411106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist