Provider Demographics
NPI:1891875464
Name:DOHR, KEVIN BRIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRIAN
Last Name:DOHR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4031
Mailing Address - Country:US
Mailing Address - Phone:406-541-2727
Mailing Address - Fax:
Practice Address - Street 1:128 S 6TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4031
Practice Address - Country:US
Practice Address - Phone:406-541-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT286103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000491556Medicaid