Provider Demographics
NPI:1184453433
Name:WATSON, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:ROUND MOUNTAIN
Mailing Address - State:CA
Mailing Address - Zip Code:96084-0228
Mailing Address - Country:US
Mailing Address - Phone:530-337-5750
Mailing Address - Fax:
Practice Address - Street 1:1401 GOLD ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1937
Practice Address - Country:US
Practice Address - Phone:530-337-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator