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NPI Code Detail

MEDICARE: DOMINIQUE DAMARA BURNS

MEDICARE:   DOMINIQUE DAMARA BURNS
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
1101YM0800XMental Health Counselor15007NV

General Provider Information

NPI Number : 1508294828
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE DAMARA BURNS
Provider Business Mailing Address
First Line : 7040 LAREDO ST STE K
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-3044
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7040 LAREDO ST STE K
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-3044
Country : US
Telephone Number : 702-331-4874
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2013
Last Update Date : 06/23/2021

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Directions to “ DOMINIQUE DAMARA BURNS ” Practice Location

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