Kimberley D Dockery, PH.D., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

T1550 Issued in OR

Practice address

19250 SW 65TH Ave Ste 300
Tualatin, OR 97062-7707

Phone

(503) 692-1242

Fax

(503) 691-3615

NPI assigned

Sep 6, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/c-f-d/r4/

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.

• Center for Family Development, Inc.

  • Mental Health Counselor
  • Eugene, OR
  • NPI 1265609184
  NPD (past)
• Center for Family Development, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Eugene, OR
  • NPI 1538150388
  NPD (past)

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

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1710236757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7650 SW BEVELAND RD STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972238692",
            "telephone_number": "503-601-3615",
            "fax_number": "503-646-1683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19250 SW 65TH AVE STE 300",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627707",
            "telephone_number": "503-692-1242",
            "fax_number": "503-691-3615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOCKERY",
        "first_name": "KIMBERLEY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PH.D., LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-06",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NE",
            "license": "9734",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T1550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500705290",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John David Dipaola, MD
• Katherine Mychal Dipietro, CNM
• DK Pathology
• DLH Occupational Therapy, LLC
• Ruby Ngoc Doan, PHARM.D.
• Donald R Olson, MD, Facs, LLC (Donald Olson, MD, Facs)
• Lynda Donnelly-Crites, ND
• Charles Herbert Doolittle III, M.D.
• Jay Paul Douglass, MD
• Jeffrey Matthew Douglass, MD

• Marriage & Family Therapist in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; 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.