Watershed Group of Dallas, PLLC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

63770 Issued in TX

Legal business name

WATERSHED GROUP OF DALLAS, PLLC

Doing business as

Lifeologie Plano Richardson

Practice address

3600 Shire Blvd Ste 208
Richardson, TX 75082-2238

Phone

(214) 556-0996

NPI assigned

Aug 12, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ly Hai Tran, LPS-SUPERVISOR

Title

Owner/Executive Director

Phone

(214) 556-0996

Specialties & licenses 1

Addresses

Other names 1

• Lifeologie Plano Richardson Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1245755081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 SHIRE BLVD STE 208",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822238",
            "telephone_number": "214-556-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 SHIRE BLVD STE 208",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822238",
            "telephone_number": "214-556-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERSHED GROUP OF DALLAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "LY",
        "authorized_official_middle_name": "HAI",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "214-556-0996",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPS-SUPERVISOR"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "TX",
            "license": "63770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifeologie Plano Richardson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Xavbryelle Aasher Warren
• Tracy Warrick, MSN RNC NNP
• Lacravionne Washington
• Sarah Washington
• Watershed Group of Camden
• Watershed Initiative
• Caroline Leigh Watson, LCDC, LPC-INTERN
• Deshawna Watson
• James Mathew Watson, DDS
• James Mathew Watson Jr., D.D.S.

• Counselor in Richardson, TX
• Providers in Richardson, TX by specialty
• Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.