MEDICARE: LASHAUN NIKKI WATSON

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	106H00000X	Marriage & Family Therapist	152848	CA
2	224Z00000X	Occupational Therapy Assistant	3046	CA

General Provider Information

NPI Number	:	1922820612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHAUN NIKKI WATSON

Provider Business Mailing Address
First Line	:	4451 LAMONT WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-1918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9412 BIG HORN BLVD STE 6
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-1101
Country	:	US
Telephone Number	:	916-609-5155
Fax Number	:

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

Provider Enumeration Date	:	10/25/2024
Last Update Date	:	05/27/2026

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Directions to “ LASHAUN NIKKI WATSON ” Practice Location

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