MEDICARE: MS. PAULA VALERIA DOMINGUEZ

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	13530	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	568	OK
3	101YP2500X	Professional Counselor	63747	TX
4	101YM0800X	Mental Health Counselor	63747	TX
5	101YP2500X	Professional Counselor	3082	OK

General Provider Information

NPI Number	:	1841381613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULA VALERIA DOMINGUEZ

Provider Business Mailing Address
First Line	:	3788 RICHMOND AVE APT 1359
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77046-3714
Country	:	US
Telephone Number	:	713-456-9965
Fax Number	:	713-864-9004

Provider Business Practice Location Address
First Line	:	1100 MERRILL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-6009
Country	:	US
Telephone Number	:	713-984-6614
Fax Number	:	713-864-9004

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	02/21/2022

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