Provider Demographics
NPI:1720409659
Name:DAUGHERTY, KATHRYN COLLEEN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:COLLEEN
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:13407 E 223RD ST
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-9643
Mailing Address - Country:US
Mailing Address - Phone:816-508-3721
Mailing Address - Fax:816-508-3739
Practice Address - Street 1:421 E 137TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1455
Practice Address - Country:US
Practice Address - Phone:816-508-3721
Practice Address - Fax:816-508-3739
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013044248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional