Provider Demographics
NPI:1407401219
Name:WATFORD, TAMIKAH ALYSSA (LPC)
Entity Type:Individual
Prefix:
First Name:TAMIKAH
Middle Name:ALYSSA
Last Name:WATFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MIKAH
Other - Middle Name:
Other - Last Name:WATFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10730 POTRANCO RD STE 122-486
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3327
Mailing Address - Country:US
Mailing Address - Phone:210-970-2126
Mailing Address - Fax:
Practice Address - Street 1:10730 POTRANCO RD STE 122-486
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3327
Practice Address - Country:US
Practice Address - Phone:210-970-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor