Provider Demographics
NPI:1760793871
Name:WATSON, TONI LECHENE
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LECHENE
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5028
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-0028
Mailing Address - Country:US
Mailing Address - Phone:323-333-1001
Mailing Address - Fax:
Practice Address - Street 1:923 S CATALINA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4718
Practice Address - Country:US
Practice Address - Phone:310-792-5454
Practice Address - Fax:310-792-5463
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CAIMF58819106H00000X
CAIMF84568106H00000X
CALMFT130467106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health