Active NPI
Diane Domeier, LMFT
- Marriage & Family Therapist
- Modesto, CA
National Provider Identifier
1508068529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 80621
- Practice address
- 1729 Tully Rd Ste 4
Modesto, CA 95350-4081 - Phone
- (209) 450-6563
- Fax
- (209) 284-0408
- NPI assigned
- Jun 1, 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 80621 | CA | Primary |
Addresses
Primary practice location
1729 Tully Rd Ste 4
Modesto, CA 95350-4081
Mailing address
1729 Tully Road
Ste 4
Modesto, CA 95350
Phone (209) 450-6563
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80621 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1508068529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1729 TULLY ROAD",
"address_2": "STE 4",
"city": "MODESTO",
"state": "CA",
"postal_code": "95350",
"telephone_number": "209-450-6563",
"fax_number": "209-284-0408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1729 TULLY RD STE 4",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504081",
"telephone_number": "209-450-6563",
"fax_number": "209-284-0408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMEIER",
"first_name": "DIANE",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-01",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "80621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.