Active NPI
Lisette C Domiteaux, PH. D.
- Mental Health Counselor
- Dallas, TX
National Provider Identifier
1265561005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 8717
- Practice address
- 5925 Forest Lane
Suite 202
Dallas, TX 75230-8805 - Phone
- (214) 363-0277
- Fax
- (214) 352-5388
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 8717 | TX | Primary |
Addresses
Primary practice location
5925 Forest Lane
Suite 202
Dallas, TX 75230-8805
Mailing address
5925 Forest Lane
Suite 202
Dallas, TX 75230-8805
Phone (214) 363-0277
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 752231883 | Other | TX | FEDERAL TAX ID |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8717 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704758400000",
"number": "1265561005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5925 FOREST LANE",
"address_2": "SUITE 202",
"city": "DALLAS",
"state": "TX",
"postal_code": "752308805",
"telephone_number": "214-363-0277",
"fax_number": "214-352-5388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5925 FOREST LANE",
"address_2": "SUITE 202",
"city": "DALLAS",
"state": "TX",
"postal_code": "752308805",
"telephone_number": "214-363-0277",
"fax_number": "214-352-5388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMITEAUX",
"first_name": "LISETTE",
"middle_name": "C",
"credential": "PH. D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2024-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "8717",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "752231883",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.