Daugherty, Douglas A.

Daugherty, Douglas A. is an individual health care provider with primary practice located at 5230 S Western Ave , Marion IN 46953-5778. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Daugherty, Douglas A. can be contacted via phone (765) 674-2208.

Contact Information

Primary practice address
5230 S Western Ave Marion IN 46953-5778
Phone: (765) 674-2208
Fax: (765) 674-3273
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 20041195A Indiana

Profile Details

NPI number 1881745453
LBN Legal business name Daugherty, Douglas A.
Credentials PSY.D.,HSPP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2007
Last updated Jun 15th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881745453 NPPES
Indiana Other 160445000 MAGELLAN
Indiana MEDICAID 200858320 MAGELLAN
Indiana Other 000000249176 MAGELLAN
Indiana Other 7580201 MAGELLAN

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