Active NPI
Jon M Domachowski, M.A., PLPC
- Counselor
- Saint Louis, MO
National Provider Identifier
1558658807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 2011020016
- Practice address
- 1 University Blvd
Saint Louis, MO 63121-4400 - Phone
- (314) 516-7231
- Fax
- (314) 516-6624
- NPI assigned
- Jul 7, 2011
- Last updated
- Jul 7, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 2011020016 | MO | Primary |
Addresses
Primary practice location
1 University Blvd
Saint Louis, MO 63121-4400
Mailing address
1 University Blvd
Saint Louis, MO 63121-4400
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 |
|---|---|---|---|
| 2011020016 | MO | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309996800000",
"number": "1558658807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 UNIVERSITY BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631214400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 UNIVERSITY BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631214400",
"telephone_number": "314-516-7231",
"fax_number": "314-516-6624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMACHOWSKI",
"first_name": "JON",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "M.A., PLPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-07",
"last_updated": "2011-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MO",
"license": "2011020016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.