Provider Demographics
NPI:1699212902
Name:DOMINGUEZ, JEANETTE (LPC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 PRESTON OAKS RD APT 106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8425
Mailing Address - Country:US
Mailing Address - Phone:915-217-8092
Mailing Address - Fax:
Practice Address - Street 1:5565 PRESTON OAKS RD APT 106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8425
Practice Address - Country:US
Practice Address - Phone:915-217-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional