Individual
BRANDON JACOB DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4210 MEADOWLARK LN SE, RIO RANCHO, NM 87124-1021
(505) 560-9355
Mailing address
4210 MEADOWLARK LN SE, RIO RANCHO, NM 87124-1021
(505) 560-9355
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/12/2023
Last updated
12/18/2023
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