Provider Demographics
NPI:1831118256
Name:WATSON, LISA D (MC, LAC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:D
Last Name:WATSON
Suffix:
Gender:F
Credentials:MC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26275 N 82ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-1451
Mailing Address - Country:US
Mailing Address - Phone:480-220-9258
Mailing Address - Fax:
Practice Address - Street 1:3603 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3638
Practice Address - Country:US
Practice Address - Phone:602-234-1935
Practice Address - Fax:602-234-0022
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health