MEDICARE: DOMINO FAMILY SERVICES, LLC

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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1306796008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINO FAMILY SERVICES, LLC

Provider Business Mailing Address
First Line	:	2962 S PREENING WAY
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-5547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2962 S PREENING WAY
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-5547
Country	:	US
Telephone Number	:	810-610-9925
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DUANE M DOMINO
Credential	:	LMFT
Telephone Number	:	810-610-9925

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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