Provider Demographics
NPI:1184771115
Name:DAUGHERTY, NANCY ELAINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELAINE
Last Name:DAUGHERTY
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 1:10008 OAKLEAF RD # 401
Mailing Address - Street 2:
Mailing Address - City:CADET
Mailing Address - State:MO
Mailing Address - Zip Code:63630-8108
Mailing Address - Country:US
Mailing Address - Phone:636-337-0590
Mailing Address - Fax:573-701-0330
Practice Address - Street 1:118 W PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1403
Practice Address - Country:US
Practice Address - Phone:573-701-0330
Practice Address - Fax:573-701-0330
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000145537101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor