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NPI Code Detail

MEDICARE: LINDA M DOMERESE DMIN, LPCC

MEDICARE: LINDA M DOMERESE DMIN, LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0488KY

General Provider Information

NPI Number : 1255367215
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA M DOMERESE DMIN, LPCC
Provider Business Mailing Address
First Line : 2720 FREDERICA ST
Second Line :
City : OWENSBORO
State : KY
Zip : 42301-5442
Country : US
Telephone Number : 270-685-0110
Fax Number :
Provider Business Practice Location Address
First Line : 2720 FREDERICA ST
Second Line :
City : OWENSBORO
State : KY
Zip : 42301-5442
Country : US
Telephone Number : 270-685-0110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 07/08/2007

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Directions to “ LINDA M DOMERESE DMIN, LPCC” Practice Location

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