Active NPI
Jorge Dominguez Jr.
- Professional Counselor
- Portland, TX
National Provider Identifier
1306399290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 72077
- Practice address
- 2004 Westwood Dr
Portland, TX 78374-3007 - Phone
- (956) 740-2661
- NPI assigned
- Jul 27, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12693 | TX | |
| Professional Counselor | 101YP2500X | 72077 | TX | Primary |
Addresses
Primary practice location
2004 Westwood Dr
Portland, TX 78374-3007
Mailing address
2004 Westwood Dr
Portland, TX 78374-3007
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12693 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469577600000",
"number": "1306399290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2004 WESTWOOD DR",
"city": "PORTLAND",
"state": "TX",
"postal_code": "783743007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2004 WESTWOOD DR",
"city": "PORTLAND",
"state": "TX",
"postal_code": "783743007",
"telephone_number": "956-740-2661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "JORGE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-27",
"last_updated": "2016-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "12693",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "72077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.