Provider Demographics
NPI:1598077828
Name:WATSON, EDWYNA ANN (LPC, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:EDWYNA
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHESTNUT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-1440
Mailing Address - Country:US
Mailing Address - Phone:325-676-8963
Mailing Address - Fax:325-676-2915
Practice Address - Street 1:100 CHESTNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1440
Practice Address - Country:US
Practice Address - Phone:325-676-8963
Practice Address - Fax:325-676-2915
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9575101YA0400X
TX63751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212326701Medicaid