=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912422593
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN TAYLOR DOMINGUEZ MS, LCADC, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2017
-----------------------------------------------------
Last Update Date | 11/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 SAFE HARBOR WAY
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89512-1137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-787-9411
-----------------------------------------------------
Fax | 775-787-9445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 SAFE HARBOR WAY
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89512-1137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-787-9411
-----------------------------------------------------
Fax | 775-787-9445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 07856-LC
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 11837-C
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------