Provider Demographics
NPI:1457741597
Name:MOGNETT, DOMINIQUE FELICE (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:FELICE
Last Name:MOGNETT
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 CHUCK GRAY CT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7306
Mailing Address - Country:US
Mailing Address - Phone:832-423-1916
Mailing Address - Fax:
Practice Address - Street 1:1100 WALNUT ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2956
Practice Address - Country:US
Practice Address - Phone:270-689-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00216535101YP2500X
KY162650101YP2500X
KY172273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional