Provider Demographics
NPI:1093864936
Name:DOMIAN, ALAN CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:CHARLES
Last Name:DOMIAN
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 1:4200 SOMERSET DR
Mailing Address - Street 2:SUITE 254
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5217
Mailing Address - Country:US
Mailing Address - Phone:913-381-1810
Mailing Address - Fax:913-381-1836
Practice Address - Street 1:4200 SOMERSET DR
Practice Address - Street 2:SUITE 254
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5217
Practice Address - Country:US
Practice Address - Phone:913-381-1810
Practice Address - Fax:913-381-1836
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS752103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist