Individual
SHELLI HAZEL WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
116 AGNES AVE, SANTA MARIA, CA 93458-2838
(805) 457-3724
Mailing address
212 CARMEN LN STE 201, SANTA MARIA, CA 93458-7771
(805) 212-7680
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
40616
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205480563
TELECARE CORPORATION-AGNES AVE
CA
01
—
1245897354
TELECARE CORPORATION
CA
Enumeration date
11/05/2015
Last updated
10/29/2019
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