Provider Demographics
NPI:1306040696
Name:WATSON, CHARLA (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHARLA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10814 O MALLY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-3793
Mailing Address - Country:US
Mailing Address - Phone:281-999-3699
Mailing Address - Fax:512-310-9991
Practice Address - Street 1:12027 BLUE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-1020
Practice Address - Country:US
Practice Address - Phone:281-537-6498
Practice Address - Fax:512-310-9991
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional