Provider Demographics
NPI:1720486137
Name:DAUGHERTY, TAHANI ALEXIS (LICSW)
Entity Type:Individual
Prefix:
First Name:TAHANI
Middle Name:ALEXIS
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TAHANI
Other - Middle Name:ALEXIS
Other - Last Name:AL-SALEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23712 105TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-8748
Mailing Address - Country:US
Mailing Address - Phone:720-646-1328
Mailing Address - Fax:
Practice Address - Street 1:23712 105TH ST SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-8748
Practice Address - Country:US
Practice Address - Phone:425-409-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2555741041C0700X
WA611688441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical