Provider Demographics
NPI:1487128781
Name:DAUGHTREY, DOE (LMSW)
Entity type:Individual
Prefix:
First Name:DOE
Middle Name:
Last Name:DAUGHTREY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E CALLE MADERAS
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2909
Mailing Address - Country:US
Mailing Address - Phone:480-861-0865
Mailing Address - Fax:
Practice Address - Street 1:1425 W ELLIOT RD STE 201
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5142
Practice Address - Country:US
Practice Address - Phone:480-462-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-17582104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker