Jonathan Dominguez, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

11740 SW 68TH Pkwy Ste 200
Tigard, OR 97223-9058

Phone

(503) 597-8393

NPI assigned

Jun 10, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Youth Villages

  • Community/Behavioral Health Agency
  • Lake Oswego, OR
  • NPI 1740729490
  NPD (past)
• Youth Villages

  • Adolescent and Children Mental Health Clinic/Center
  • Lake Oswego, OR
  • NPI 1992243992
  NPD (past)

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

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1487279923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 W GLOUCESTER ST",
            "city": "GLADSTONE",
            "state": "OR",
            "postal_code": "970272059",
            "telephone_number": "406-529-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11740 SW 68TH PKWY STE 200",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972239058",
            "telephone_number": "503-597-8393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "JONATHAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-10",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanette Elizabeth Dodge, L.AC.
• Melissa Lynne Dodson
• Dawna Marie Doering
• Aiaa Doghda, PHARMACIST
• Chelsey Lee Dolence, BS
• Brian Keith Dominicci, LPN
• Maia Donahue
• Christina Donaldson
• Steven Michael Donaldson, L.P.C.
• Xiangjun Dong, LAC

• Mental Health Counselor in Tigard, OR
• Providers in Tigard, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.