Provider Demographics
NPI:1841381613
Name:DOMINGUEZ, PAULA VALERIA
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:VALERIA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3788 RICHMOND AVE APT 1359
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-3714
Mailing Address - Country:US
Mailing Address - Phone:713-456-9965
Mailing Address - Fax:713-864-9004
Practice Address - Street 1:1100 MERRILL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-6009
Practice Address - Country:US
Practice Address - Phone:713-984-6614
Practice Address - Fax:713-864-9004
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13530101YA0400X
OK568101YA0400X
TX63747101YP2500X, 101YM0800X
OK3082101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional