Provider Demographics
NPI:1942387311
Name:WATSON, CHARLYN L (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHARLYN
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CHARLYN
Other - Middle Name:L
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1715 FM 1626
Mailing Address - Street 2:STE 105 #4
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3553
Mailing Address - Country:US
Mailing Address - Phone:512-496-0010
Mailing Address - Fax:512-292-1144
Practice Address - Street 1:1715 FM 1626
Practice Address - Street 2:STE 105 #4
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3553
Practice Address - Country:US
Practice Address - Phone:512-496-0010
Practice Address - Fax:512-292-1144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional