Provider Demographics
NPI:1164700647
Name:DAVALOS, DOMINGO DAVALOS (LPC)
Entity Type:Individual
Prefix:MR
First Name:DOMINGO
Middle Name:DAVALOS
Last Name:DAVALOS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E LEONA ST
Mailing Address - Street 2:
Mailing Address - City:DILLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78017-3938
Mailing Address - Country:US
Mailing Address - Phone:830-965-6393
Mailing Address - Fax:830-965-4602
Practice Address - Street 1:213 E LEONA ST
Practice Address - Street 2:
Practice Address - City:DILLEY
Practice Address - State:TX
Practice Address - Zip Code:78017-3938
Practice Address - Country:US
Practice Address - Phone:830-965-6393
Practice Address - Fax:830-965-4602
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional