Healthcare Provider Details

I. General information

NPI: 1528975778
Provider Name (Legal Business Name): DOMINIQUA BYERS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 MILL CREEK BLVD STE G1
MILL CREEK WA
98012-1279
US

IV. Provider business mailing address

315 147TH AVE SE
SNOHOMISH WA
98290-5606
US

V. Phone/Fax

Practice location:
  • Phone: 425-362-2914
  • Fax:
Mailing address:
  • Phone: 425-610-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: