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Individual

AMANDA DOUGHERTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSY.D.

Contact information

Practice address
3401 W TRUMAN BLVD STE 100, JEFFERSON CITY, MO 65109-5752
(573) 644-7909
(573) 644-7908
Mailing address
1041 JOHN SIMS PKWY E, NICEVILLE, FL 32578-2712
(850) 389-8489
(844) 377-9201

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
2006031373
MO
103TC0700X
Clinical Psychologist
Primary
PY9351
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
497336206
MO
Enumeration date
04/17/2006
Last updated
08/15/2023
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