Provider Demographics
NPI:1760032924
Name:DOMINGUEZ, JARED (LMFT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8285 SW NIMBUS AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6428
Mailing Address - Country:US
Mailing Address - Phone:503-610-2044
Mailing Address - Fax:
Practice Address - Street 1:8285 SW NIMBUS AVE STE 130
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6428
Practice Address - Country:US
Practice Address - Phone:503-610-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT2309106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist