Individual
JACINDA ELAINE DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
3757 S. GREYSTONE CT., SPRINGFIELD, MO 65804-0000
(417) 877-7500
(417) 877-7600
Mailing address
3757 S. GREYSTONE CT., SPRINGFIELD, MO 65804-0000
(417) 877-7500
(417) 877-7600
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2001031418
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152184
BLUE SHIELD
MO
05
—
495693707
—
MO
Enumeration date
02/26/2007
Last updated
10/02/2008
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