Active NPI
Charles W. Watson, PSYD
- Clinical Psychologist
- Springfield, MO
National Provider Identifier
1144227562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 01741
- Practice address
- 1911 S National Ave
Suite 407
Springfield, MO 65804-2219 - Phone
- (417) 234-9987
- NPI assigned
- Jun 30, 2005
- Last updated
- Aug 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 01741 | MO | Primary |
Addresses
Primary practice location
1911 S National Ave
Suite 407
Springfield, MO 65804-2219
Mailing address
1911 S National Ave
Suite 407
Springfield, MO 65804-2219
Phone (417) 234-9987
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01741 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186963200000",
"number": "1144227562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1911 S NATIONAL AVE",
"address_2": "SUITE 407",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658042219",
"telephone_number": "417-234-9987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1911 S NATIONAL AVE",
"address_2": "SUITE 407",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658042219",
"telephone_number": "417-234-9987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "CHARLES",
"middle_name": "W.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-30",
"last_updated": "2007-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "01741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.