Basic Information
| Provider Information | |||||||||
| NPI: | 1679120356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | BRIANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| OtherLastName: | WATSON | ||||||||
| OtherFirstName: | BREE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6850 MORRO RD | ||||||||
| Address2: | |||||||||
| City: | ATASCADERO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934224123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054342449 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6850 MORRO RD | ||||||||
| Address2: | |||||||||
| City: | ATASCADERO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934224123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054342449 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2019 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 122767 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.