Provider Demographics
NPI:1659674612
Name:WATSON, GINA WILKERSON (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:WILKERSON
Last Name:WATSON
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 STONELEIGH DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6924
Mailing Address - Country:US
Mailing Address - Phone:713-443-9787
Mailing Address - Fax:
Practice Address - Street 1:9925 KATY FRWY
Practice Address - Street 2:STE 420
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-443-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201632106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist