Provider Demographics
NPI:1841665460
Name:KURTZ-DOUGHERTY, SIMONE (LPC, LPCC, LMHC,)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:KURTZ-DOUGHERTY
Suffix:
Gender:F
Credentials:LPC, LPCC, LMHC,
Other - Prefix:
Other - First Name:SIMONE
Other - Middle Name:
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:1895 AVENIDA DEL ORO # 4723
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5800
Mailing Address - Country:US
Mailing Address - Phone:760-547-7445
Mailing Address - Fax:
Practice Address - Street 1:1895 AVENIDA DEL ORO # 4723
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5800
Practice Address - Country:US
Practice Address - Phone:760-547-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00738700101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health