Provider Demographics
NPI:1790989895
Name:WATSON, PENNY CONNER (LMFT)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:CONNER
Last Name:WATSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:PENNY
Other - Middle Name:WATSON
Other - Last Name:BERND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1509 W 108TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2641
Mailing Address - Country:US
Mailing Address - Phone:918-694-3399
Mailing Address - Fax:918-499-1598
Practice Address - Street 1:7010 S YALE AVE STE 215
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5743
Practice Address - Country:US
Practice Address - Phone:918-492-2552
Practice Address - Fax:918-499-1598
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK614106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist