Healthcare Provider Details

I. General information

NPI: 1699609065
Provider Name (Legal Business Name): JENNIFER DOMINGO, LMFT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 10/02/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9130 NOLAN ST
ELK GROVE CA
95758
US

IV. Provider business mailing address

100 N HOWARD ST # 10372
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 916-513-0468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER DOMINGO
Title or Position: LMFT
Credential: LMFT
Phone: 916-513-0468