1003609843 NPI number — PINA-WATSON PSYCHOLOGICAL SERVICES, PLLC

Table of content: (NPI 1003609843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003609843 NPI number — PINA-WATSON PSYCHOLOGICAL SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINA-WATSON PSYCHOLOGICAL SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003609843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10204 HOMESTEAD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79424-3880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-407-7201
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3223 S LOOP 289 STE 416
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-1365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-454-5191
Provider Business Practice Location Address Fax Number:
806-482-1639
Provider Enumeration Date:
05/24/2025

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
BRANDY
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST, OWNER
Authorized Official Telephone Number:
806-454-5191

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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