Individual provider Active NPI

Victoria C Domangue, BCBA, LBA

  • Behavior Analyst
  • Houma, LA
National Provider Identifier
1073179628
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
L-369 Issued in LA
Practice address
108 Picone Rd
Houma, LA 70363-7051
Phone
(985) 860-3752
Fax
(985) 208-3051
NPI assigned
May 18, 2019
Last updated
Feb 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X L-369 LA Primary

Addresses

Primary practice location

108 Picone Rd
Houma, LA 70363-7051

Mailing address

108 Picone Rd
Houma, LA 70363-7051
Phone (985) 860-3752

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
L-369LAMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum of Possibilities, LLC Behavior Analyst Current Accepting new patients

Locations

108 Picone Rd
Houma, LA 70363
Phone (985) 226-3178

826 School St
Houma, LA 70360
Phone (985) 804-2112

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644192000000",
    "number": "1073179628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 PICONE RD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703637051",
            "telephone_number": "985-860-3752",
            "fax_number": "985-208-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 PICONE RD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703637051",
            "telephone_number": "985-860-3752",
            "fax_number": "985-208-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMANGUE",
        "first_name": "VICTORIA",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-18",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "LA",
            "license": "L-369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houma, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.