Healthcare Provider Details

I. General information

NPI: 1215671995
Provider Name (Legal Business Name): DOMINIQUE RANICE SCOTT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

270 EAST LN
BURLINGAME CA
94010-2802
US

V. Phone/Fax

Practice location:
  • Phone: 800-516-0975
  • Fax:
Mailing address:
  • Phone: 800-516-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: