Provider Demographics
NPI:1134003452
Name:DOMINGUEZ, KERRI LYNN ELMINA (LAC, CCTS-I)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN ELMINA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:LAC, CCTS-I
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:LYNN ELMINA
Other - Last Name:BULLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13178 E MINETA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2522
Mailing Address - Country:US
Mailing Address - Phone:520-349-3708
Mailing Address - Fax:
Practice Address - Street 1:1580 N KOLB RD STE 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4933
Practice Address - Country:US
Practice Address - Phone:520-284-6887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health