Individual
DR. DIANE L DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4301 GARTH RD, SUITE 400, BAYTOWN, TX 77521
(281) 420-8400
Mailing address
PO BOX 66308, HOUSTON, TX 77016
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
3323
TX
103T00000X
Psychologist
2-4826
TX
103TC0700X
Clinical Psychologist
Primary
24826
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091752801
—
TX
Enumeration date
11/18/2005
Last updated
09/12/2013
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