MEDICARE: LINDSAY W DOUGHERTY LPC

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	101YP2500X	Professional Counselor		CO

General Provider Information

NPI Number	:	1932601705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDSAY W DOUGHERTY LPC

Provider Business Mailing Address
First Line	:	320 E FONTANERO ST STE 301
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7526
Country	:	US
Telephone Number	:	719-358-9301
Fax Number	:	719-355-1435

Provider Business Practice Location Address
First Line	:	320 E FONTANERO ST STE 301
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7526
Country	:	US
Telephone Number	:	719-358-9301
Fax Number	:	719-355-1435

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MELANIE ANDRESS
Credential	:
Telephone Number	:	719-358-9301

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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