Active NPI
Kimberly Sue Dominic, MA
- Marriage & Family Therapist
- Colorado Springs, CO
National Provider Identifier
1548440035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 956
- Practice address
- 1440 E Fountain Blvd
Colorado Springs, CO 80910-3502 - Phone
- (719) 238-7264
- NPI assigned
- Nov 13, 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 | 956 | CO | Primary |
Addresses
Primary practice location
1440 E Fountain Blvd
Colorado Springs, CO 80910-3502
Mailing address
3155 Hollycrest Dr
Colorado Springs, CO 80920-3014
Phone (719) 235-1826
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 956 | CO | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490832000000",
"number": "1548440035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3155 HOLLYCREST DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809203014",
"telephone_number": "719-235-1826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1440 E FOUNTAIN BLVD",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809103502",
"telephone_number": "719-238-7264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINIC",
"first_name": "KIMBERLY",
"middle_name": "SUE",
"name_prefix": "Mr.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-13",
"last_updated": "2017-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CO",
"license": "956",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.