Kenneth Allen Dougherty, CRM, QMHA-I

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

25-CRM-4553 Issued in OR

Practice address

12540 SW Main St Ste 202
Tigard, OR 97223-6198

Phone

(503) 906-9995

NPI assigned

Sep 22, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Recovery Works NW LLC

  • Multi-Specialty Clinic/Center
  • Tigard, OR
  • NPI 1083010094
  NPD
• Recovery Works NW LLC

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1871264416
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1194234096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12540 SW MAIN ST STE 202",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236198",
            "telephone_number": "503-906-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12540 SW MAIN ST STE 202",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236198",
            "telephone_number": "503-906-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "KENNETH",
        "middle_name": "ALLEN",
        "credential": "CRM, QMHA-I",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-22",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "25-CRM-4553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Joan Dornblaser, STUDENT INTERN
• Sheeten B Doshi, M.D.
• Keith W Doty, DDS
• Jeremy Doud
• Lillian Dougalas
• Hannah Douglass, MS CCC-SLP
• Dove Tail LLC
• Jennifer Dowhaniuk, LPC
• Leah M Dowling
• Deborah Downing, M.A.

• Peer Specialist in Tigard, OR
• Providers in Tigard, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.