Provider Demographics
NPI:1770379042
Name:WATSON, BRANDY MICHELLE (LP)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:MICHELLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:LP
Other - Prefix:DR
Other - First Name:BRANDY
Other - Middle Name:MICHELLE
Other - Last Name:PINA-WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LP
Mailing Address - Street 1:10204 HOMESTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3880
Mailing Address - Country:US
Mailing Address - Phone:806-407-7201
Mailing Address - Fax:
Practice Address - Street 1:3223 S LOOP 289 STE 416
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1365
Practice Address - Country:US
Practice Address - Phone:806-454-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39113103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist