MEDICARE: TWANNA MONIQUE WATSON 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
1	101YP2500X	Professional Counselor	77042	TX

General Provider Information

NPI Number	:	1457064495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TWANNA MONIQUE WATSON LPC

Provider Business Mailing Address
First Line	:	730 W GRAND AVE APT 214
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-2580
Country	:	US
Telephone Number	:	832-881-0258
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 W GRAND AVE UNIT 3103
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-2581
Country	:	US
Telephone Number	:	832-881-0258
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	01/04/2023

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