Provider Demographics
NPI:1699356865
Name:GULIZO, DOMINICK ANTHONY III
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:ANTHONY
Last Name:GULIZO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 STANLEY AVE APT 130
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-2957
Mailing Address - Country:US
Mailing Address - Phone:469-226-5901
Mailing Address - Fax:817-516-9102
Practice Address - Street 1:2901 STANLEY AVE APT 130
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-2957
Practice Address - Country:US
Practice Address - Phone:469-226-5901
Practice Address - Fax:817-516-9102
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor