MEDICARE: MERCEDES MARIA DOMINGUEZ M.ED., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	12169	TX

General Provider Information

NPI Number	:	1326134065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES MARIA DOMINGUEZ M.ED., LPC

Provider Business Mailing Address
First Line	:	12826 WILLOW CENTRE DRIVE
Second Line	:	SUITE F
City	:	HOUSTON
State	:	TX
Zip	:	77066-3028
Country	:	US
Telephone Number	:	281-440-0606
Fax Number	:	281-631-0413

Provider Business Practice Location Address
First Line	:	12826 WILLOW CENTRE DRIVE
Second Line	:	SUITE F
City	:	HOUSTON
State	:	TX
Zip	:	77066-3028
Country	:	US
Telephone Number	:	281-440-0606
Fax Number	:	281-631-0413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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