Provider Demographics
NPI:1285773572
Name:DOUGHERTY, KIMBERLY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:MALLEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5151 N PALM AVE
Mailing Address - Street 2:#890
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2208
Mailing Address - Country:US
Mailing Address - Phone:559-225-8960
Mailing Address - Fax:559-225-8901
Practice Address - Street 1:5151 N PALM AVE
Practice Address - Street 2:#890
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2208
Practice Address - Country:US
Practice Address - Phone:559-225-8960
Practice Address - Fax:559-225-8901
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAPSY10076103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist