Provider Demographics
NPI:1174841209
Name:DOMINGUEZ, DEBORAH (MFT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 LINDERO CANYON ROAD
Mailing Address - Street 2:STE. 726
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3626
Mailing Address - Country:US
Mailing Address - Phone:805-206-1455
Mailing Address - Fax:
Practice Address - Street 1:5655 LINDERO CANYON RD
Practice Address - Street 2:STE. 726
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4016
Practice Address - Country:US
Practice Address - Phone:805-206-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist