Healthcare Provider Details

I. General information

NPI: 1316300429
Provider Name (Legal Business Name): MISTY DAWN WATKINS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MISTY DAWN WEAVER

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S 7TH ST
CHICKASHA OK
73018-4406
US

IV. Provider business mailing address

1010 S 7TH ST
CHICKASHA OK
73018-4406
US

V. Phone/Fax

Practice location:
  • Phone: 580-284-8729
  • Fax: 580-771-2012
Mailing address:
  • Phone: 580-284-8729
  • Fax: 580-771-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTPMC7818
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7252
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTLC2746PC
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: