Provider Demographics
NPI:1740763457
Name:DAUGHERTY, DARREN J (PHD, LPC, RPT, CFLE)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:J
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:PHD, LPC, RPT, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 LONE ELM RD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-8119
Mailing Address - Country:US
Mailing Address - Phone:972-921-8459
Mailing Address - Fax:
Practice Address - Street 1:133 CHIEFTAIN DR STE 105
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1587
Practice Address - Country:US
Practice Address - Phone:810-373-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional