Provider Demographics
NPI:1114783743
Name:DOMINGO THERAPY A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DOMINGO THERAPY A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-513-0466
Mailing Address - Street 1:5716 FOLSOM BLVD # 348
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4608
Mailing Address - Country:US
Mailing Address - Phone:916-234-3139
Mailing Address - Fax:
Practice Address - Street 1:4127 SANTA ROSA AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-3442
Practice Address - Country:US
Practice Address - Phone:916-234-3139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty