Provider Demographics
NPI:1760517494
Name:DOUGHERTY, LINDSAY WALLACE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:WALLACE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3553
Mailing Address - Country:US
Mailing Address - Phone:719-291-6239
Mailing Address - Fax:
Practice Address - Street 1:320 E FONTANERO ST STE 301
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7526
Practice Address - Country:US
Practice Address - Phone:719-358-9103
Practice Address - Fax:719-355-1435
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional