MEDICARE: DOMINO EFFECTS

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1861383234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINO EFFECTS

Provider Business Mailing Address
First Line	:	12650 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4256
Country	:	US
Telephone Number	:	817-618-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	12650 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4256
Country	:	US
Telephone Number	:	817-618-2212
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	KRISTINE WATKINS
Credential	:
Telephone Number	:	310-796-6456

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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Directions to “DOMINO EFFECTS ” Practice Location

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