Provider Demographics
NPI:1669707097
Name:DOUGHERTY, JENNIFER LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17103 PRESTON RD
Mailing Address - Street 2:SUITE 288
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1332
Mailing Address - Country:US
Mailing Address - Phone:469-251-0803
Mailing Address - Fax:
Practice Address - Street 1:17103 PRESTON RD
Practice Address - Street 2:SUITE 288
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1332
Practice Address - Country:US
Practice Address - Phone:469-251-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20192101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor