Provider Demographics
NPI:1013226943
Name:WATKINS, SHIRLEY JOAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:JOAN
Last Name:WATKINS
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 1:108 W JASPER ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-1020
Mailing Address - Country:US
Mailing Address - Phone:573-378-6833
Mailing Address - Fax:573-378-6823
Practice Address - Street 1:108 W JASPER ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1020
Practice Address - Country:US
Practice Address - Phone:573-378-6833
Practice Address - Fax:573-378-6823
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010030790103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical