Provider Demographics
NPI:1700236791
Name:DAUGHERTY, JOEL (MA, LPC-S)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 DEER WALK
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70615-4776
Mailing Address - Country:US
Mailing Address - Phone:337-221-5831
Mailing Address - Fax:
Practice Address - Street 1:1117 KIRKMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5317
Practice Address - Country:US
Practice Address - Phone:337-414-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health