Healthcare Provider Details

I. General information

NPI: 1760793871
Provider Name (Legal Business Name): TONI LECHENE WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 S CATALINA AVE
REDONDO BEACH CA
90277-4718
US

IV. Provider business mailing address

PO BOX 5028
LONG BEACH CA
90805-0028
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-5454
  • Fax: 310-792-5463
Mailing address:
  • Phone: 323-333-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF58819
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF84568
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT130467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: