Provider Demographics
NPI:1497295745
Name:DOUGHERTY, LORI ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 DETROIT ST APT 111
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1696
Mailing Address - Country:US
Mailing Address - Phone:720-388-0126
Mailing Address - Fax:
Practice Address - Street 1:1530 DETROIT ST APT 111
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1696
Practice Address - Country:US
Practice Address - Phone:720-388-0126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00124989101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor