Provider Demographics
NPI:1245869163
Name:MARTIN-DOEHRING, KERRY JEAN (MA, LMFT, IMH-E)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:JEAN
Last Name:MARTIN-DOEHRING
Suffix:
Gender:F
Credentials:MA, LMFT, IMH-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 N. 79TH AVE
Mailing Address - Street 2:SUITE C-50
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:480-744-0765
Mailing Address - Fax:623-328-9539
Practice Address - Street 1:18001 N. 79TH AVE
Practice Address - Street 2:SUITE C-50
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:480-744-0765
Practice Address - Fax:623-328-9539
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT15410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist