Provider Demographics
NPI:1003011453
Name:DOMINEY, SALLIE JANE
Entity Type:Individual
Prefix:
First Name:SALLIE
Middle Name:JANE
Last Name:DOMINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 SW D AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4619
Practice Address - Country:US
Practice Address - Phone:580-250-1222
Practice Address - Fax:580-250-1795
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor