Watershed Group of Camden

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

WATERSHED GROUP OF CAMDEN

Doing business as

Lifeologie

Practice address

3600 Shire Blvd Ste 208
Richardson, TX 75082-2238

Phone

(856) 355-8785

NPI assigned

Mar 28, 2023

Organization subpart

Yes

Parent organization

WATERSHED GROUP OF CAMDENAs reported in NPPES

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

Authorized official

Name

Ly Tran

Title

Owner

Phone

(856) 355-8785

Specialties & licenses 1

Addresses

Other names 1

• Lifeologie Doing business as

Part of

Watershed Group of Camden

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679961600000",
    "number": "1780388322",
    "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"
        },
        {
            "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": "856-355-8785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERSHED GROUP OF CAMDEN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WATERSHED GROUP OF CAMDEN",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "LY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-355-8785"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifeologie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robynn Winona Warren, M.S, CCC-SLP
• Xavbryelle Aasher Warren
• Tracy Warrick, MSN RNC NNP
• Lacravionne Washington
• Sarah Washington
• Watershed Group of Dallas, PLLC
• Watershed Initiative
• Caroline Leigh Watson, LCDC, LPC-INTERN
• Deshawna Watson
• James Mathew Watson, DDS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.