Provider Demographics
NPI:1962015370
Name:LEWIS DOMINGUEZ, SHANNA (MED, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:
Last Name:LEWIS DOMINGUEZ
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 LEXINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2174
Mailing Address - Country:US
Mailing Address - Phone:832-567-7234
Mailing Address - Fax:
Practice Address - Street 1:1406 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2174
Practice Address - Country:US
Practice Address - Phone:346-241-1416
Practice Address - Fax:346-239-1415
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78889103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist