Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 31780 | TX |
Y | 103TC0700X | Clinical Psychologist | 31780 | TX |
NPI | 1003825001 |
---|---|
Provider Name | Dr. Lisa Michelle Watts |
First Address | Kerrville, TX 78028-4950 |
Second Address | Kerrville, TX 78028-4950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 30/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0025HV | BCBS (01) | TX |
147606103 | (05) | TX |