MEDICARE: CYNTHIA DOMINGUEZ LPC

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	101YP2500X	Professional Counselor	86862	TX

General Provider Information

NPI Number	:	1518745868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA DOMINGUEZ LPC

Provider Business Mailing Address
First Line	:	1408 N RIVERFRONT BLVD STE 180
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-3912
Country	:	US
Telephone Number	:	214-810-1565
Fax Number	:

Provider Business Practice Location Address
First Line	:	2621 CAROLWOOD LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-2912
Country	:	US
Telephone Number	:	214-810-1565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	03/09/2026

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