Basic Information
| Provider Information | |||||||||
| NPI: | 1619353380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | JANNIE | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 NW 5TH ST | ||||||||
| Address2: | |||||||||
| City: | GUYMON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 739424240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803382117 | ||||||||
| FaxNumber: | 5803381262 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 NW 5TH ST | ||||||||
| Address2: | |||||||||
| City: | GUYMON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 739424240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803382117 | ||||||||
| FaxNumber: | 5803381262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2015 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 7263 | OK | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.