=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376451518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TABATHA MAYE DOMINEY MA, LPC-ASSOCIATE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2026
-----------------------------------------------------
Last Update Date | 08/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2906 W 13TH ST
-----------------------------------------------------
City | BIG SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79720-4063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-201-9892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 616 CAYLOR DR
-----------------------------------------------------
City | BIG SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79720-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-271-0446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 103730
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------