Provider Demographics
NPI:1629263934
Name:DOUGHERTY, ASHLEY TAYLOR (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:TAYLOR
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:LORRAINE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:65 N MADISON AVE
Mailing Address - Street 2:SUITE 614
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2035
Mailing Address - Country:US
Mailing Address - Phone:626-344-8561
Mailing Address - Fax:
Practice Address - Street 1:65 N MADISON AVE
Practice Address - Street 2:SUITE 614
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2035
Practice Address - Country:US
Practice Address - Phone:626-344-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24629103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical