Healthcare Provider Details

I. General information

NPI: 1922820612
Provider Name (Legal Business Name): LASHAUN NIKKI WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9412 BIG HORN BLVD STE 6
ELK GROVE CA
95758-1101
US

IV. Provider business mailing address

4451 LAMONT WAY
SACRAMENTO CA
95823-1918
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152848
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: