MEDICARE: EIGHT DOMAINS 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1730767542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EIGHT DOMAINS LLC

Provider Business Mailing Address
First Line	:	115 CONLEY RD # 1032
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-6465
Country	:	US
Telephone Number	:	573-212-4456
Fax Number	:	573-970-3007

Provider Business Practice Location Address
First Line	:	1500 FELLOWS PL APT 3C
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8529
Country	:	US
Telephone Number	:	573-212-4456
Fax Number	:	573-970-3007

Authorized Official
Title or Position	:	OWNER
Name	:	AMBER LIPONOGA
Credential	:	LCSWQ
Telephone Number	:	573-212-4456

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	03/31/2025

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