Healthcare Provider Details

I. General information

NPI: 1245869163
Provider Name (Legal Business Name): KERRY JEAN MARTIN-DOEHRING MA, LMFT, IMH-E
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18001 N. 79TH AVE SUITE C-50
GLENDALE AZ
85308
US

IV. Provider business mailing address

18001 N. 79TH AVE SUITE C-50
GLENDALE AZ
85308
US

V. Phone/Fax

Practice location:
  • Phone: 480-744-0765
  • Fax: 623-328-9539
Mailing address:
  • Phone: 480-744-0765
  • Fax: 623-328-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT15410
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: