Provider Demographics
NPI:1255443552
Name:TAVERNIER, DOMINIQUE M (LMFT)
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:M
Last Name:TAVERNIER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 E PRENTICE AVE
Mailing Address - Street 2:D12
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2759
Mailing Address - Country:US
Mailing Address - Phone:303-654-2555
Mailing Address - Fax:303-779-7982
Practice Address - Street 1:8000 E PRENTICE AVE
Practice Address - Street 2:D12
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2759
Practice Address - Country:US
Practice Address - Phone:303-654-2555
Practice Address - Fax:303-779-7982
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO183OtherPROFESSIONAL LICENSE LMFT