Provider Demographics
NPI:1003825001
Name:WATTS, LISA MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:WATTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 COMMERCE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4950
Mailing Address - Country:US
Mailing Address - Phone:830-792-5542
Mailing Address - Fax:830-792-4546
Practice Address - Street 1:123 COMMERCE ST
Practice Address - Street 2:SUITE A
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4950
Practice Address - Country:US
Practice Address - Phone:830-792-4477
Practice Address - Fax:830-792-4546
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31780103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025HVOtherBCBS
TX147606103Medicaid
TX147606103Medicaid