- Practice location
- 12540 SW Main St Ste 202, Tigard, OR 97223-6198
- Phone
- 503-906-9995
- Fax
- —
- Last updated
- September 30, 2025
Kenneth Allen Dougherty is a Peer Specialist based in Tigard, OR. Kenneth Allen Dougherty practices in Tigard, OR and has the professional credentials of CRM, QMHA-I. The NPI Number for Kenneth Allen Dougherty is 1194234096 and holds a License No. 25-CRM-4553 (OR). The current practice location address for Kenneth Allen Dougherty is 12540 SW Main St Ste 202, Tigard, OR 97223-6198 and can be reached out via phone at 503-906-9995.
Provider Profile Details
- NPI Number
- 1194234096
- Provider Name
- Kenneth Allen Dougherty
- Credential
- CRM, QMHA-I
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 12540 SW Main St Ste 202, Tigard, OR 97223-6198
- Phone Number
- 503-906-9995
- Primary Taxonomy
- Peer Specialist · 175T00000X
- Sole Proprietor
- Yes
- Provider Enumeration Date
- September 22, 2017
- Last Update Date
- September 30, 2025
- Certification Date
- September 30, 2025
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 12540 SW Main St Ste 202
Tigard, OR 97223-6198 - City
- Tigard
- State
- Oregon
- Zip
- 97223-6198
- Phone Number
- 503-906-9995
Provider Business Mailing Address Details
- Address
- 12540 SW Main St Ste 202
Tigard, OR 97223-6198 - City
- Tigard
- State
- OR
- Zip
- 97223-6198
- Phone Number
- 503-906-9995
License Information
- License Number
- 25-CRM-4553
- License State
- OR
- Taxonomy
- Peer Specialist · 175T00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Peer Specialists near Tigard, OR
View all Peer Specialists in Tigard →Frequently Asked Questions
What is the NPI number of Kenneth A Dougherty, CRM, QMHA-I?
The NPI number of Kenneth A Dougherty, CRM, QMHA-I is 1194234096. It was assigned on September 22, 2017 and is currently active in the NPPES registry.
What is the specialty of Kenneth A Dougherty, CRM, QMHA-I?
Kenneth A Dougherty, CRM, QMHA-I is registered under the primary taxonomy Peer Specialist (code 175T00000X), licensed in OR under license number 25-CRM-4553.
Where does Kenneth A Dougherty, CRM, QMHA-I practice?
The practice location is 12540 SW Main St Ste 202, Tigard, OR 97223-6198. The office can be reached at 503-906-9995 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1194234096 directly on the NPPES registry website.