Courtney L Domingue, MA, BCBA, LBA, IBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-17-27891

Practice address

2253 Crossbow St
Minneola, FL 34715-9315

Phone

(210) 290-6575

NPI assigned

Sep 22, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

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

• Success Shaping LLC

  • Behavior Analyst
  • Minneola, FL
  • NPI 1073382230
  NPD Authorized official
• Georgia a. Hall Behavior Consulting Services, LLC

  • Behavior Analyst
  • Warsaw, VA
  • NPI 1902682800
  NPD (past)

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

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746316800000",
    "number": "1144739145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2253 CROSSBOW ST",
            "city": "MINNEOLA",
            "state": "FL",
            "postal_code": "347159315",
            "telephone_number": "210-290-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2253 CROSSBOW ST",
            "city": "MINNEOLA",
            "state": "FL",
            "postal_code": "347159315",
            "telephone_number": "210-290-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUE",
        "first_name": "COURTNEY",
        "middle_name": "L",
        "credential": "MA, BCBA, LBA, IBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-22",
        "last_updated": "2025-05-04",
        "certification_date": "2025-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-17-27891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BACB - BOARD CERTIFIED BEHAVIOR ANALYST",
            "identifier": "1-17-27891",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNATIONAL BEHAVIOR ANALYSIS ORGANIZATION - INTERNATIONAL BEHAVIOR ANALYST",
            "identifier": "27502033",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF MEDICINE - LICENSED BEHAVIOR ANALYST",
            "identifier": "0133003246",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS DEPARTMENT OF LICENSING AND REGULATION - LICENSED BEHAVIOR ANALYST",
            "identifier": "1067",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blake Desenti
• Chantale Deus Pierre, LCSW
• Richard Jerrid Dewalden, LMHC
• Dianand Rajigadoo
• Jeremiah Doll
• Dr Aaron Pazik LLC
• Dynamic Health Concepts LLC
• Edxo Imaging Health Group LLC
• Georgina El-Baba
• Endearing Touch in Home Care LLC

• Behavior Analyst in Minneola, FL
• Providers in Minneola, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2025; 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.