Provider Demographics
NPI:1932945656
Name:WATSON, TRESHA (PLPC)
Entity type:Individual
Prefix:MRS
First Name:TRESHA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1889
Mailing Address - Country:US
Mailing Address - Phone:314-368-2409
Mailing Address - Fax:314-442-4139
Practice Address - Street 1:10828 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-1508
Practice Address - Country:US
Practice Address - Phone:314-368-2409
Practice Address - Fax:314-442-4139
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024008814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2024008814OtherLICENSE