Provider Demographics
NPI:1790769677
Name:DAUGHERTY, KATHERINE JOANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOANNE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2715
Mailing Address - Country:US
Mailing Address - Phone:317-253-7820
Mailing Address - Fax:
Practice Address - Street 1:4040 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-7800
Practice Address - Country:US
Practice Address - Phone:317-876-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-03
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001542A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist