Provider Demographics
NPI:1730622812
Name:WATSON, JARED A (LMFT & LPC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:A
Last Name:WATSON
Suffix:
Gender:M
Credentials:LMFT & LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 S VISTA CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1937
Mailing Address - Country:US
Mailing Address - Phone:816-405-6531
Mailing Address - Fax:
Practice Address - Street 1:2904 S VISTA CT
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1937
Practice Address - Country:US
Practice Address - Phone:816-405-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015002796101YP2500X
VA0701005546101YP2500X
MO2015004635106H00000X
VA0717001326106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional