Provider Demographics
NPI:1548723570
Name:WATSON, RESHANA SHIMANNA
Entity type:Individual
Prefix:
First Name:RESHANA
Middle Name:SHIMANNA
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:PO BOX 3218
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93385-3218
Mailing Address - Country:US
Mailing Address - Phone:661-873-4927
Mailing Address - Fax:661-273-4928
Practice Address - Street 1:2000 BAKER ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-3061
Practice Address - Country:US
Practice Address - Phone:661-873-4927
Practice Address - Fax:661-873-4928
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112742101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional