Tahani Alexis Daugherty, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

61168844 Issued in WA

Practice address

23712 105TH St SE
Monroe, WA 98272-8748

Phone

(425) 409-9671

NPI assigned

Dec 17, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Tahani Alexis Al-Salem Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Well Space Therapy, PLLC

  • Adult Mental Health Clinic/Center
  • Monroe, WA
  • NPI 1407563653
  NPD Authorized official
• Brock Family Therapy Center Inc.

  • Adult Mental Health Clinic/Center
  • Louisville, KY
  • NPI 1609250992
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1720486137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23712 105TH ST SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982728748",
            "telephone_number": "720-646-1328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23712 105TH ST SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982728748",
            "telephone_number": "425-409-9671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "TAHANI",
        "middle_name": "ALEXIS",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-17",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "255574",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "61168844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAHANI",
            "last_name": "AL-SALEM",
            "middle_name": "ALEXIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charles Arthur Cutter III, MOT, OTR/L SWC
• Steven Douglas Daggett, CDP
• Christi Dahlgren, PA-C
• Rodney J Dahlinger, D.C.
• James A Dauer, LMHC
• Joan Marie Daves
• Harrison Davis, LMHC
• Sarah Davison, LMFT
• Jenn Dazey, N.D.
• DDK, PLLC

• Clinical Social Worker in Monroe, WA
• Providers in Monroe, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.