Individual
DR. DOUGLAS A. DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.,HSPP
Contact information
Practice address
5230 S WESTERN AVE, MARION, IN 46953-5778
(765) 674-2208
(765) 674-3273
Mailing address
5230 S WESTERN AVE, MARION, IN 46953-5778
(765) 674-2208
(765) 674-3273
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041195A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000249176
ANTHEMBCBS
IN
01
—
160445000
MAGELLAN
IN
05
—
200858320
—
IN
01
—
7580201
AETNA
IN
Enumeration date
01/12/2007
Last updated
06/15/2016
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