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NPI Code Detail

MEDICARE: TYNISA WATSON MA,NCC,LPC

MEDICARE: TYNISA WATSON MA,NCC,LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1285102004
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYNISA WATSON MA,NCC,LPC
Provider Business Mailing Address
First Line : 1400 S AUSTIN BLVD
Second Line :
City : CICERO
State : IL
Zip : 60804-1003
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 S AUSTIN BLVD
Second Line :
City : CICERO
State : IL
Zip : 60804-1003
Country : US
Telephone Number : 708-329-4052
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2018
Last Update Date : 11/09/2018

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Directions to “ TYNISA WATSON MA,NCC,LPC” Practice Location

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