Individual
LACEY WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 BEATTY ST, MEDFORD, OR 97501-5811
(541) 476-2373
(541) 414-0740
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
(541) 774-7979
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C5493
OR
Other
Enumeration date
03/23/2012
Last updated
01/05/2026
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