Provider Demographics
NPI:1861999799
Name:DOMINGUEZ, SANDRA (LMFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DOMINGUEZ
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 1:6802 N OAK DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8365
Mailing Address - Country:US
Mailing Address - Phone:281-755-7238
Mailing Address - Fax:
Practice Address - Street 1:17240 MILL FOREST RD STE A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4366
Practice Address - Country:US
Practice Address - Phone:281-755-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist