Active NPI
Jaclyn Watson
- Mental Health Counselor
- Puyallup, WA
National Provider Identifier
1245759109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MC60405100
- Practice address
- 417 E Pioneer Ste B
Puyallup, WA 98372-3267 - Phone
- (253) 987-6425
- NPI assigned
- Sep 12, 2017
- Last updated
- Sep 12, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC60405100 | WA | Primary |
Addresses
Primary practice location
417 E Pioneer Ste B
Puyallup, WA 98372-3267
Mailing address
1618 Amber Blvd
Puyallup, WA 98372-5230
Phone (541) 206-7859
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 9, 2025 through Jan 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC60405100 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505174400000",
"number": "1245759109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1618 AMBER BLVD",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983725230",
"telephone_number": "541-206-7859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 E PIONEER STE B",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983723267",
"telephone_number": "253-987-6425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "JACLYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-12",
"last_updated": "2017-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "MC60405100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.