Provider Demographics
NPI:1386077949
Name:WATSON, TAMARA CORRINE MARIE
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:CORRINE MARIE
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SW EDGEWAY DR
Mailing Address - Street 2:APT. 201
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3994
Mailing Address - Country:US
Mailing Address - Phone:503-270-0062
Mailing Address - Fax:
Practice Address - Street 1:290 SW EDGEWAY DR
Practice Address - Street 2:APT. 201
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3994
Practice Address - Country:US
Practice Address - Phone:503-270-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-17
Last Update Date:2013-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health