Healthcare Provider Details

I. General information

NPI: 1205293768
Provider Name (Legal Business Name): KAYCE DOMINGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3648 BELLE VALE DR
ADDIS LA
70710-3059
US

IV. Provider business mailing address

3648 BELLE VALE DR
ADDIS LA
70710-3059
US

V. Phone/Fax

Practice location:
  • Phone: 225-263-6385
  • Fax:
Mailing address:
  • Phone: 225-263-6385
  • Fax: 225-263-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7371
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7371
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number7371
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: