Provider Demographics
NPI:1922790070
Name:DAUGHERTY, JOSHUA RAPHAEL (LPC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RAPHAEL
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:RAFI
Other - Middle Name:
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:7509 BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2817
Mailing Address - Country:US
Mailing Address - Phone:303-569-7774
Mailing Address - Fax:
Practice Address - Street 1:1575 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:303-569-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional