Provider Demographics
NPI:1194877852
Name:DOMINGOS-SHEPARD, ELIZABETH MARIA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:DOMINGOS-SHEPARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 CAMINO DIABLO
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3985
Mailing Address - Country:US
Mailing Address - Phone:925-407-7084
Mailing Address - Fax:707-297-6265
Practice Address - Street 1:2920 CAMINO DIABLO
Practice Address - Street 2:SUITE 160
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3985
Practice Address - Country:US
Practice Address - Phone:925-407-7084
Practice Address - Fax:707-297-6265
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist