Provider Demographics
NPI:1255709606
Name:DOMON, URAINA (MSW)
Entity type:Individual
Prefix:
First Name:URAINA
Middle Name:
Last Name:DOMON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-0030
Mailing Address - Country:US
Mailing Address - Phone:660-359-4487
Mailing Address - Fax:660-359-2958
Practice Address - Street 1:1102 W HELM ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-7309
Practice Address - Country:US
Practice Address - Phone:660-359-4487
Practice Address - Fax:660-359-2958
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180052561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical