Healthcare Provider Details

I. General information

NPI: 1023935954
Provider Name (Legal Business Name): KIMBERLY DOUGHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CORONADO CT BLDG 7
FORT COLLINS CO
80525-4929
US

IV. Provider business mailing address

109 CORONADO CT BLDG 7
FORT COLLINS CO
80525-4929
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-9190
  • Fax:
Mailing address:
  • Phone: 970-335-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0014891
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: