Provider Demographics
NPI:1831537307
Name:WATSON, TOBY TYLER (PSYD)
Entity type:Individual
Prefix:DR
First Name:TOBY
Middle Name:TYLER
Last Name:WATSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 KOHLER MEMORIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3177
Mailing Address - Country:US
Mailing Address - Phone:920-208-7226
Mailing Address - Fax:
Practice Address - Street 1:2808 KOHLER MEMORIAL DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3166
Practice Address - Country:US
Practice Address - Phone:920-208-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2563-057103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic