1013170224 NPI number — MRS. ALLYSON LEONTAY WATSON LMFT

Table of content: MRS. ALLYSON LEONTAY WATSON LMFT (NPI 1013170224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013170224 NPI number — MRS. ALLYSON LEONTAY WATSON LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON
Provider First Name:
ALLYSON
Provider Middle Name:
LEONTAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
ALLYSON
Provider Other Middle Name:
LEONTAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013170224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 W VICTORIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMPTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90220-5804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-868-5379
Provider Business Mailing Address Fax Number:
310-868-5398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4625 PISTACHIO LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPITOL HEIGHTS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20743-7352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-265-2699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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