Provider Demographics
NPI:1558193953
Name:MUNERLYN, DOMINIQUE N (LCSW)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:N
Last Name:MUNERLYN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9659 N SAM HOUSTON PKWY E STE 150
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1290
Mailing Address - Country:US
Mailing Address - Phone:713-398-1437
Mailing Address - Fax:
Practice Address - Street 1:9659 N SAM HOUSTON PKWY E STE 150
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1290
Practice Address - Country:US
Practice Address - Phone:713-398-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX614171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical