Provider Demographics
NPI:1740450048
Name:DAUGHERTY, SHAWN F (BA IN PSYCHOLOGY)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:F
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:BA IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 FOWLER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-5461
Mailing Address - Country:US
Mailing Address - Phone:719-210-8181
Mailing Address - Fax:
Practice Address - Street 1:1010 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3726
Practice Address - Country:US
Practice Address - Phone:719-327-2042
Practice Address - Fax:719-634-0482
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor