Provider Demographics
NPI:1871302588
Name:WATSON, BRODERICK THOMAS
Entity type:Individual
Prefix:
First Name:BRODERICK
Middle Name:THOMAS
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 YBGR LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-3507
Mailing Address - Country:US
Mailing Address - Phone:406-671-3330
Mailing Address - Fax:
Practice Address - Street 1:1780 YBGR LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-3507
Practice Address - Country:US
Practice Address - Phone:406-671-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health