Provider Demographics
NPI:1881487627
Name:WATSON, TYNESHIA
Entity type:Individual
Prefix:
First Name:TYNESHIA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 HIGHWAY 365 STE A
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7719
Mailing Address - Country:US
Mailing Address - Phone:409-527-4347
Mailing Address - Fax:
Practice Address - Street 1:4700 HIGHWAY 365 STE A
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7719
Practice Address - Country:US
Practice Address - Phone:409-527-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health