Provider Demographics
NPI:1487951786
Name:WATSON, AMY MARIE (PHD,,LPC-S)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIE
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD,,LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E WHITENER RD
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-8546
Mailing Address - Country:US
Mailing Address - Phone:817-734-9635
Mailing Address - Fax:
Practice Address - Street 1:406 E WHITENER RD
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-8546
Practice Address - Country:US
Practice Address - Phone:817-734-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19481101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor