Basic Information
| Provider Information | |||||||||
| NPI: | 1831218957 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR RAY WATSON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1629 BLUE SPRUCE DR | ||||||||
| Address2: | STE 208 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805245415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704950300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4674 SNOW MESA DR | ||||||||
| Address2: | STE 140 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805288615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704820213 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 97049503000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D MIN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4468 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.