Provider Demographics
NPI:1982052635
Name:WATSON, CHRISTOPHER GENE (PSYD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GENE
Last Name:WATSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30200 AGOURA RD STE 190
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5431
Mailing Address - Country:US
Mailing Address - Phone:818-981-7845
Mailing Address - Fax:818-459-3787
Practice Address - Street 1:30200 AGOURA RD STE 190
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5431
Practice Address - Country:US
Practice Address - Phone:818-981-7845
Practice Address - Fax:818-459-3787
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3389103T00000X
CA33067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist