Provider Demographics
NPI:1891429809
Name:WATSON, TANYA (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:FLAHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2885 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3952
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:
Practice Address - Street 1:3401 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8372
Practice Address - Country:US
Practice Address - Phone:573-777-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220324181041C0700X
MO00001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0000Medicaid