Jessica Domke, LPC, ATR

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2022037793 Issued in MO

Practice address

12143 Old Saint Charles Rd
Bridgeton, MO 63044-2816

Phone

(314) 656-6113

NPI assigned

Nov 20, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 22, 2026 through Apr 22, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1763596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1083575989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12143 OLD SAINT CHARLES RD",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442816",
            "telephone_number": "314-656-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12143 OLD SAINT CHARLES RD",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442816",
            "telephone_number": "314-656-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMKE",
        "first_name": "JESSICA",
        "credential": "LPC, ATR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-11-20",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2022037793",
            "primary": true
        },
        {
            "code": "221700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Art Therapist",
            "state": "MO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.