Individual
THEODORE ANTHONY WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1941 S 42ND ST, STE 540, OMAHA, NE 68105-2939
(402) 558-2034
(402) 614-1540
Mailing address
1941 S 42ND ST, STE 540, OMAHA, NE 68105-2939
(402) 558-2034
(402) 614-1540
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
150
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26
—
NE
Enumeration date
12/22/2006
Last updated
07/08/2007
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