Provider Demographics
NPI:1972212546
Name:DOUGHTY, LEAH (LPC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:DOUGHTY
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 1:3130 TAMARACK CT APT 929
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8034
Mailing Address - Country:US
Mailing Address - Phone:260-224-8776
Mailing Address - Fax:
Practice Address - Street 1:3130 TAMARACK CT APT 929
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8034
Practice Address - Country:US
Practice Address - Phone:260-224-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health