Active NPI
Crystal Diane Watson, MSW, SWAICL
- Mental Health Counselor
- Othello, WA
National Provider Identifier
1770028375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 61021724
- Practice address
- 425 E Main St Ste 600
Othello, WA 99344-1146 - Phone
- (509) 488-5611
- Fax
- (509) 488-0166
- NPI assigned
- Jan 5, 2017
- Reactivated
- Jan 13, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 60865152 | WA | |
| Mental Health Counselor | 101YM0800X | 61021724 | WA | Primary |
Addresses
Primary practice location
425 E Main St Ste 600
Othello, WA 99344-1146
Mailing address
425 E Main St Ste 600
Othello, WA 99344-1146
Phone (509) 488-5611
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2144691 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60865152 | WA | MD | Mental Health Counselor |
| 61021724 | WA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Adams | Mental Health | Past | Accepting new patients |
| County of Adams | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Othello, WA
- NPI 1487905154
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580688000000",
"number": "1770028375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 E MAIN ST STE 600",
"city": "OTHELLO",
"state": "WA",
"postal_code": "993441146",
"telephone_number": "509-488-5611",
"fax_number": "509-488-0166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 E MAIN ST STE 600",
"city": "OTHELLO",
"state": "WA",
"postal_code": "993441146",
"telephone_number": "509-488-5611",
"fax_number": "509-488-0166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "CRYSTAL",
"middle_name": "DIANE",
"name_prefix": "Ms.",
"credential": "MSW, SWAICL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-05",
"last_updated": "2020-02-03",
"certification_date": "2020-02-03",
"deactivation_date": "2019-12-16",
"reactivation_date": "2020-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "60865152",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "61021724",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2144691",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Othello, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.