Provider Demographics
NPI:1699544007
Name:DOMINGUEZ AREVALO PALACIOS, JANETCI LILIANA (LCSW)
Entity type:Individual
Prefix:
First Name:JANETCI
Middle Name:LILIANA
Last Name:DOMINGUEZ AREVALO PALACIOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANETCI
Other - Middle Name:LILIANA
Other - Last Name:AREVALO PALACIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2222 WELBORN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3924
Mailing Address - Country:US
Mailing Address - Phone:814-559-7406
Mailing Address - Fax:
Practice Address - Street 1:2222 WELBORN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3924
Practice Address - Country:US
Practice Address - Phone:214-559-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX69328OtherTEXAS BEHAVIORAL EXECUTIVE COUNCIL