MEDICARE: ANJANETTE DAUGHERTY MS, LPC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH21879	FL
2	101YP2500X	Professional Counselor	C2934	OR

General Provider Information

NPI Number	:	1215624598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJANETTE DAUGHERTY MS, LPC, LMHC

Provider Business Mailing Address
First Line	:	1769 PALM DR
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-2731
Country	:	US
Telephone Number	:	727-324-3149
Fax Number	:

Provider Business Practice Location Address
First Line	:	1769 PALM DR
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-2731
Country	:	US
Telephone Number	:	727-324-3149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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