Healthcare Provider Details

I. General information

NPI: 1710236757
Provider Name (Legal Business Name): KIMBERLEY D DOCKERY PH.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 SW 65TH AVE STE 300
TUALATIN OR
97062-7707
US

IV. Provider business mailing address

7650 SW BEVELAND RD STE 200
PORTLAND OR
97223-8692
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-1242
  • Fax: 503-691-3615
Mailing address:
  • Phone: 503-601-3615
  • Fax: 503-646-1683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number9734
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1550
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: