Provider Demographics
NPI:1619079555
Name:DAUGETT, JUDY GWYN (MA)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:GWYN
Last Name:DAUGETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:SAMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1721
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76241-1721
Mailing Address - Country:US
Mailing Address - Phone:940-612-0049
Mailing Address - Fax:940-612-0049
Practice Address - Street 1:1001 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4237
Practice Address - Country:US
Practice Address - Phone:940-612-0049
Practice Address - Fax:940-612-0049
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00170BOtherBLUE CROSS
TX028647801Medicaid