Provider Demographics
NPI:1114487501
Name:THORNTON, KATIE DOUGHERTY
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:DOUGHERTY
Last Name:THORNTON
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 1:8000 RESEARCH FOREST DR STE 115
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1506
Mailing Address - Country:US
Mailing Address - Phone:832-422-6726
Mailing Address - Fax:
Practice Address - Street 1:25722 HICKORY PECAN TRL
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1974
Practice Address - Country:US
Practice Address - Phone:832-422-6726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker