Healthcare Provider Details

I. General information

NPI: 1831520477
Provider Name (Legal Business Name): PHILIPPA KORNELIA WATKINS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E ST STE 305
EUREKA CA
95501-0351
US

IV. Provider business mailing address

PO BOX 2281
MCKINLEYVILLE CA
95519-2281
US

V. Phone/Fax

Practice location:
  • Phone: 707-677-8554
  • Fax:
Mailing address:
  • Phone: 707-677-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number73823
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number97086
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number73823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: