Provider Demographics
NPI:1821221177
Name:WATSON, THEOPHLIUS III (LCSW)
Entity type:Individual
Prefix:MR
First Name:THEOPHLIUS
Middle Name:
Last Name:WATSON
Suffix:III
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HESSELRIDGE
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-4401
Mailing Address - Country:US
Mailing Address - Phone:505-227-4338
Mailing Address - Fax:
Practice Address - Street 1:1061 HESSELRIDGE
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-4401
Practice Address - Country:US
Practice Address - Phone:505-227-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-082521041C0700X, 171M00000X
TX108525171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator