Domonique Louis, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

29321 Issued in TN

Practice address

2502 Mount Moriah Rd Ste A101
Memphis, TN 38115-1539

Phone

(800) 892-2695

NPI assigned

Mar 11, 2021

Last updated

Feb 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, TN, CA, OH, KS5 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 5

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Affect Therapeutics Inc

  dba Affect Therapeutics

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Charlottesville, VA
  • NPI 1104402064

  CA, OH, Psychiatric/Mental Health, TN, TX

  Medicare reassignment NPD
• Cerebral Unlimited LLC

  dba Cerebral Spa

  • Clinic/Center
  • Overland Park, KS
  • NPI 1336939693
  Medicare reassignment NPD
• Goal Mind Inc.

  dba Goal Mind

  • Psychiatry Physician
  • Memphis, TN
  • NPI 1053093195
  NPD Authorized official
• Affect Therapeutics, Inc.

  • Adult Mental Health Clinic/Center
  • Athens, OH
  • NPI 1528878832
  NPD
• Ford 4F, LLC

  dba Cerebral Spa

  • Clinic/Center
  • Overland Park, KS
  • NPI 1346019189
  NPD
• Affect Therapeutics Inc

  • Adult Mental Health Clinic/Center
  • King City, OR
  • NPI 1780489468
  NPD (past)
• Affect Therapeutics, Inc.

  • Adult Mental Health Clinic/Center
  • Albuquerque, NM
  • NPI 1942948351
  NPD (past)
• Cyh Medical Group (TX), P.a.

  • Clinical Psychologist
  • Austin, TX
  • NPI 1073229175

  Psychiatric/Mental Health

  NPD (past)

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1720663701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 THE GRN STE 4000",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199013618",
            "telephone_number": "844-869-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 MOUNT MORIAH RD STE A101",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381151539",
            "telephone_number": "800-892-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOUIS",
        "first_name": "DOMONIQUE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-11",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G166642",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "64857",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95019437",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61249213",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP026176",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "104470",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "29321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Stewart Blakely Lou, DDS
• Magda Lou
• Phillip Louder
• Emily May Louie
• Louis Valentine Eberle III
• Alexis Brooke Louk, DO
• Dennisdhilak Lourdusamy, MD
• Love & Empowerment Support Services LLC
• Love an Caretransportation (L.V)
• Love Is Quality Health Care Services

• Psychiatric/Mental Health Nurse Practitioner in Memphis, TN
• Providers in Memphis, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; 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.