Kelly Dominic, Imft LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

KELLY DOMINIC, IMFT LLC

Practice address

10955 Clearport Rd SW
Amanda, OH 43102-9612

Phone

(330) 730-9511

NPI assigned

Mar 16, 2023

Organization subpart

No

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

Authorized official

Name

Kelly M Dominic, LMFTNPI 1073007985

Title

Marriage and Family Therapist Owner

Phone

(330) 730-9511

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly M Dominic, LMFT

  • Marriage & Family Therapist
  • Lancaster, OH
  • NPI 1073007985
  NPD Authorized official

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

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1811698657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10955 CLEARPORT RD SW",
            "city": "AMANDA",
            "state": "OH",
            "postal_code": "431029612",
            "telephone_number": "330-730-9511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10955 CLEARPORT RD SW",
            "city": "AMANDA",
            "state": "OH",
            "postal_code": "431029612",
            "telephone_number": "330-730-9511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY DOMINIC, IMFT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "DOMINIC",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MARRIAGE AND FAMILY THERAPIST OWNER",
        "authorized_official_telephone_number": "330-730-9511",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Amanda, OH
• Providers in Amanda, OH by specialty
• Community/Behavioral Health Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; 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.