Provider Demographics
NPI:1396039715
Name:MARYANNE WATSON PHD PC
Entity Type:Organization
Organization Name:MARYANNE WATSON PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-380-8600
Mailing Address - Street 1:5172 VILLAGE CREEK DR
Mailing Address - Street 2:STE 101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4445
Mailing Address - Country:US
Mailing Address - Phone:972-380-8600
Mailing Address - Fax:972-380-2006
Practice Address - Street 1:5172 VILLAGE CREEK DR
Practice Address - Street 2:STE 101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4445
Practice Address - Country:US
Practice Address - Phone:972-380-8600
Practice Address - Fax:972-380-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB131829Medicare PIN