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General NPI Number Information
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NPI Number | 1205293768
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Entity Type | Individual
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Provider Name | KAYCE DOMINGUE
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Gender | Female
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 630 N VAUGHAN DR
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City | BRUSLY
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State | LA
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Zip | 70719-2217
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Country | US
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Telephone | 225-385-2668
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Fax | 225-343-0626
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Provider Business Mailing Address
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Address Line | 6450 LA HIGHWAY 1
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City | BATCHELOR
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State | LA
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Zip | 70715-3212
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Country | US
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Telephone | 225-492-3775
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Fax | 225-492-3782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 7371
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7371
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License Number State | LA
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