Provider Demographics
NPI:1285343244
Name:DOMINGUEZ, DENISE LEIGH (PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LEIGH
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-4303
Mailing Address - Country:US
Mailing Address - Phone:956-320-5950
Mailing Address - Fax:
Practice Address - Street 1:5414 REMINGTON DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-4303
Practice Address - Country:US
Practice Address - Phone:956-320-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional