Provider Demographics
NPI:1548759996
Name:DOUGHERTY, CATHERINE BAILEY
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:BAILEY
Last Name:DOUGHERTY
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 1:2515 W PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2415
Mailing Address - Country:US
Mailing Address - Phone:509-474-1976
Mailing Address - Fax:
Practice Address - Street 1:422 W RIVERSIDE AVE STE 501
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0302
Practice Address - Country:US
Practice Address - Phone:509-474-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health