Provider Demographics
NPI:1669562922
Name:DOUGHTY, LAURA S (MS, LMHC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 3RD AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3357
Mailing Address - Country:US
Mailing Address - Phone:509-925-2258
Mailing Address - Fax:509-925-2008
Practice Address - Street 1:109 E 3RD AVE STE 7
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3357
Practice Address - Country:US
Practice Address - Phone:509-925-2258
Practice Address - Fax:509-925-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91104330498902C013OtherTRICARE PROVIDER NUMBER
WA4304DOOtherREGENCE BS PROVIDER NUMBE