Provider Demographics
NPI:1659140952
Name:DAUGHERTY, CLAIR (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:CLAIR
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5367 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2025
Mailing Address - Country:US
Mailing Address - Phone:702-234-0667
Mailing Address - Fax:
Practice Address - Street 1:2330 PASEO DEL PRADO STE C112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1707
Practice Address - Country:US
Practice Address - Phone:702-234-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6030-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker