Provider Demographics
NPI:1205596251
Name:DOUGHERTY, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 BETTS CIR
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-2528
Mailing Address - Country:US
Mailing Address - Phone:402-619-6377
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 402D
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2944
Practice Address - Country:US
Practice Address - Phone:402-788-4846
Practice Address - Fax:402-702-0664
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12102101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor