KENNETH ALLEN DOUGHERTY CRM, QMHA-I
NPI 1194234096
Peer Specialist in Tigard, OR
- Individual
- Male
- Peer Specialist
About KENNETH DOUGHERTY
This page provides the complete NPI Profile along with additional information for Kenneth Dougherty, a provider established in Tigard, Oregon with a medical specialization in Peer Specialist. The healthcare provider is registered in the NPI registry with number 1194234096 assigned on September 2017. The practitioner's primary taxonomy code is 175T00000X with license number 25-CRM-4553 (OR). The provider is registered as an individual and his NPI record was last updated one year ago.
- NPI
- 1194234096 Verify this NPI
- Provider Name
- KENNETH ALLEN DOUGHERTY CRM, QMHA-I
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 12540 SW MAIN ST STE 202 TIGARD, OR 97223
- Location Phone
- (503) 906-9995
- Mailing Address
- 12540 SW MAIN ST STE 202 TIGARD, OR 97223
- Mailing Phone
- (503) 906-9995
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 09-22-2017
- Last Update Date
- 09-30-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Peer Specialist
- Taxonomy Code
- 175T00000X
- Type
- Other Service Providers
- License No.
- 25-CRM-4553
- License State
- OR
- Taxonomy Description
- Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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Other Providers at the Same Location
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TIGARD, OR 97223
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1194234096, enumerated as an "individual" on September 22, 2017.
The provider is located at 12540 SW MAIN ST STE 202 TIGARD, OR 97223 and the phone number is (503) 906-9995.
Peer Specialist with taxonomy code 175T00000X.
