=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710236757
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLEY D DOCKERY PH.D., LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2012
-----------------------------------------------------
Last Update Date | 03/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19250 SW 65TH AVE STE 300
-----------------------------------------------------
City | TUALATIN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97062-7707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-692-1242
-----------------------------------------------------
Fax | 503-691-3615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7650 SW BEVELAND RD STE 200
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-8692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-601-3615
-----------------------------------------------------
Fax | 503-646-1683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 9734
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | T1550
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------