Provider Demographics
NPI:1356682454
Name:DAUGHERTY, KATHY SUE
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:SUE
Last Name:DAUGHERTY
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 1:4131 NW 23RD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2664
Mailing Address - Country:US
Mailing Address - Phone:405-881-8110
Mailing Address - Fax:
Practice Address - Street 1:4131 NW 23RD ST APT 1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2664
Practice Address - Country:US
Practice Address - Phone:405-881-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor