Provider Demographics
NPI:1326460866
Name:DAUGHTY, DANIELLE (MED, BHRS)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DAUGHTY
Suffix:
Gender:F
Credentials:MED, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9117 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3213
Mailing Address - Country:US
Mailing Address - Phone:405-610-6344
Mailing Address - Fax:405-601-1730
Practice Address - Street 1:500 N MERIDIAN AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5700
Practice Address - Country:US
Practice Address - Phone:405-601-1716
Practice Address - Fax:405-601-1730
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional