Provider Demographics
NPI:1922588607
Name:WATSON, TONI J I (MS, CAC)
Entity Type:Individual
Prefix:MISS
First Name:TONI
Middle Name:J
Last Name:WATSON
Suffix:I
Gender:F
Credentials:MS, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10627 HWY 71 SOUTH
Mailing Address - Street 2:
Mailing Address - City:CHENEYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71325
Mailing Address - Country:US
Mailing Address - Phone:318-279-2751
Mailing Address - Fax:
Practice Address - Street 1:3683 S FIRST ST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-6409
Practice Address - Country:US
Practice Address - Phone:318-992-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5014101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA171MOOOOOXMedicaid