Provider Demographics
NPI:1265609952
Name:WATSON-COUCH, DAFFNEY KENDRA (MA)
Entity type:Individual
Prefix:MRS
First Name:DAFFNEY
Middle Name:KENDRA
Last Name:WATSON-COUCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:DAFFNEY
Other - Middle Name:KENDRA
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 9643
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-9643
Mailing Address - Country:US
Mailing Address - Phone:979-492-3613
Mailing Address - Fax:254-666-2857
Practice Address - Street 1:1820 GREENFIELD PLZ
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3408
Practice Address - Country:US
Practice Address - Phone:979-492-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2184223OtherCOMPSYCH