Provider Demographics
NPI:1801426820
Name:WATSON, JENNA LEIGH
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
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 1:3118 YATTIKA PL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3113
Mailing Address - Country:US
Mailing Address - Phone:310-600-4237
Mailing Address - Fax:
Practice Address - Street 1:2265 LEE RD STE 123
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1839
Practice Address - Country:US
Practice Address - Phone:310-600-4237
Practice Address - Fax:310-600-4237
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health