# MARISSA ROSE DOMINGUEZ LMFT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083403455
- **Authorized official:** MARISSA DOMINGUEZ LMFT (OWNER)
- **Authorized official phone:** (970) 203-4051

## Contact information

- **Practice address:** 150 E 29TH ST STE 237, LOVELAND, CO 80538-2765
- **Practice address phone:** (970) 203-4051
- **Mailing address:** 4359 BIRCHWOOD DR, LOVELAND, CO 80538-5618
- **Mailing address phone:** (970) 203-4051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101200000X | Drama Therapist | — | NULL | — |
| 101200000X | Drama Therapist | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |
| 221700000X | Art Therapist | — | NULL | — |
| 221700000X | Art Therapist | — | — | — |

## Other

- **Enumeration date:** 05/02/2025
- **Last updated:** 05/02/2025