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General NPI Number Information
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NPI Number | 1093519290
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Entity Type | Individual
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Provider Name | SKYLA KEYUARA BRENSHA WATSON BSW, PCCSS
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Gender | Female
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 200 FAIRLAND PL
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City | CLARKSDALE
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State | MS
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Zip | 38614-4537
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Country | US
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Telephone | 662-645-9905
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 BROWNING ROAD 520
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City | GREENWOOD
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State | MS
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Zip | 38930-6022
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Country | US
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Telephone | 662-645-9905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC3905
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License Number State | MS
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