Provider Demographics
NPI:1710674981
Name:DOMINGUEZ, NATASHA (PHD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 M. EVANS ST. #423
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER ACADEMY
Mailing Address - State:TX
Mailing Address - Zip Code:76554-9998
Mailing Address - Country:US
Mailing Address - Phone:832-619-9270
Mailing Address - Fax:
Practice Address - Street 1:106 M. EVANS ST. #423
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER ACADEMY
Practice Address - State:TX
Practice Address - Zip Code:76554-9998
Practice Address - Country:US
Practice Address - Phone:832-619-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205395106H00000X
HIMFT-896106H00000X
MI4101007411106H00000X
TX16815101YA0400X
MI6451022858101YP2500X
TX91414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional