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General NPI Number Information
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NPI Number | 1255961967
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Entity Type | Individual
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Provider Name | DUANE DOMINO
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Gender | Male
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 1549 N ROSA LN
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-5197
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Country | US
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Telephone | 810-610-9925
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Fax |
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Provider Business Mailing Address
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Address Line | 1549 N ROSA LN
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-5197
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Country | US
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Telephone | 810-610-9925
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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