Provider Demographics
NPI:1487902433
Name:DOMINGUEZ, JOEL (MA, MFT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 CRESCENT HEIGHTS ST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3602
Mailing Address - Country:US
Mailing Address - Phone:562-260-9058
Mailing Address - Fax:
Practice Address - Street 1:4050 KATELLA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3434
Practice Address - Country:US
Practice Address - Phone:562-260-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist