Provider Demographics
NPI:1972150522
Name:WATKINS, KOREY LEE
Entity Type:Individual
Prefix:DR
First Name:KOREY
Middle Name:LEE
Last Name:WATKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CAMP CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2775
Mailing Address - Country:US
Mailing Address - Phone:217-553-9331
Mailing Address - Fax:
Practice Address - Street 1:6012 W WILLIAM CANNON DR STE B103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1978
Practice Address - Country:US
Practice Address - Phone:512-891-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist