Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1194234096 Individual Practitioner Male Practitioner

Kenneth Allen Dougherty , CRM, QMHA-I

Peer Specialist • Tigard, OR

Professional Overview & Biography Verified Profile Summary

Kenneth Dougherty, CRM, QMHA-I is a registered healthcare professional specializing in Peer Specialist in Tigard, OR. Practice services are available at 12540 SW MAIN ST STE 202 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

12540 Sw Main St Ste 202

Tigard, OR 972236198

Telephone 5039069995
Associated Practice Facility / Clinic
🏢 Recovery Works Nw Llc Facility NPI 1083010094

Specialty Benchmarks & Practice Insights

Comparative analytics for Peer Specialist in Tigard, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
35 Specialists

Practicing in Tigard, OR (3408 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-09-30
Peer Specialist Primary Specialty

NUCC Taxonomy Code: 175T00000X

State License OR 25-CRM-4553

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

29 Associated Practitioners
Arya Roerig , CADC 1

Counselor - Addiction (Substance Use Disorder)

NPI 1003538554

CADC1

Megan Halbert , CRM

Peer Specialist

NPI 1043027311
Rochelle Love

Peer Specialist

NPI 1053124495
Michael Padrta

Peer Specialist

NPI 1083488480
Sara Kjeseth , CRM

Peer Specialist

NPI 1093682320
Jennifer Witten , NP

Nurse Practitioner - Adult Health

NPI 1164113064

Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
📍
Updated Practice Location September 30, 2025

Registered at 12540 SW MAIN ST STE 202, TIGARD, OR 972236198 (Tel: 5039069995)

📍
Updated Business Mailing Address September 30, 2025

Registered at 12540 SW MAIN ST STE 202, TIGARD, OR 972236198 (Tel: 5039069995)

👤
Provider Name / Credentials Updated September 30, 2025

Recorded as KENNETH DOUGHERTY, CRM, QMHA-I

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 30, 2025

Peer Specialist (License #25-CRM-4553 in OR)

NPI Profile Active September 22, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location September 22, 2017

Registered at 8915 SW CENTER ST, TIGARD, OR 972236307 (Tel: 5037263690)

📍
Updated Business Mailing Address September 22, 2017

Registered at 8915 SW CENTER ST, TIGARD, OR 972236307

👤
Provider Name / Credentials Updated September 22, 2017

Recorded as KEN DOUGHERTY

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 22, 2017

Counselor

🟢
Initial NPI Registration & Enumeration September 22, 2017

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1194234096
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 22, 2017
Last Update: September 30, 2025
Sole Proprietor: Yes

Mailing Address

12540 Sw Main St Ste 202

Tigard, OR 972236198

Phone: 5039069995

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.