Basic Information
| Provider Information | |||||||||
| NPI: | 1801342472 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | CYNTHIA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 LATIGO LN STE G | ||||||||
| Address2: | |||||||||
| City: | CANON CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812128113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192759799 | ||||||||
| FaxNumber: | 7198962874 | ||||||||
| Practice Location | |||||||||
| Address1: | 2429 S. PRAIRIE AVENUE | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195645070 | ||||||||
| FaxNumber: | 7198962874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | NLC.0106660 | CO | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.