Provider Demographics
NPI:1710697586
Name:MW PSYCHOTHERAPY
Entity Type:Organization
Organization Name:MW PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKAH
Authorized Official - Middle Name:ALYSSA
Authorized Official - Last Name:WATFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-970-2126
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 1:8231 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3356
Practice Address - Country:US
Practice Address - Phone:210-767-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty