Provider Demographics
NPI:1659098689
Name:WATTS, BRANDY TOYAI (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:TOYAI
Last Name:WATTS
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 1:2952 WOOD LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-5506
Mailing Address - Country:US
Mailing Address - Phone:972-951-2628
Mailing Address - Fax:
Practice Address - Street 1:2952 WOOD LAKE TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-5506
Practice Address - Country:US
Practice Address - Phone:972-951-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional