Healthcare Provider Details

I. General information

NPI: 1255443552
Provider Name (Legal Business Name): DOMINIQUE M TAVERNIER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 E PRENTICE AVE D12
GREENWOOD VILLAGE CO
80111-2759
US

IV. Provider business mailing address

8000 E PRENTICE AVE D12
GREENWOOD VILLAGE CO
80111-2759
US

V. Phone/Fax

Practice location:
  • Phone: 303-654-2555
  • Fax: 303-779-7982
Mailing address:
  • Phone: 303-654-2555
  • Fax: 303-779-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number183
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: