Dominique Michelle Mangano Mack, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LAC-22735 Issued in AZ

Practice address

13471 W Cornerstone Blvd
Goodyear, AZ 85395-2713

Phone

(480) 964-2273

NPI assigned

Apr 25, 2024

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1639925191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19819 W MARSHALL AVE",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853405426",
            "telephone_number": "708-209-9952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13471 W CORNERSTONE BLVD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952713",
            "telephone_number": "480-964-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGANO MACK",
        "first_name": "DOMINIQUE",
        "middle_name": "MICHELLE",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-25",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LAC-22735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Mallary, DO
• Dean Lawrence Mallory
• Emily Malone, PT, DPT
• Malvinderjit Singh MD PLLC
• Christine Marie Maneval, LPC
• Tanesha Lynn Manigo-Brown
• Jennifer Manley, RD
• Davinder Singh Mann, M.D.
• Cynthia Yvette Manon
• Karen Mansfield-Blair, PHD

• Mental Health Counselor in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.