Healthcare Provider Details

I. General information

NPI: 1083015713
Provider Name (Legal Business Name): DOMINIQUE MICHELLE BATTLE M.S., NCC, CFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 SW 68TH PKWY STE 200
TIGARD OR
97223-9058
US

IV. Provider business mailing address

877 W MINNEOLA AVE UNIT 120946
CLERMONT FL
34712-7039
US

V. Phone/Fax

Practice location:
  • Phone: 541-252-7595
  • Fax: 321-348-5786
Mailing address:
  • Phone: 407-951-4207
  • Fax: 321-348-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR12124
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: