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Individual
TYE DOMINGUEZ
Active
Individual
TYE DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCAC, LMHC, NCC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001723A
IN
101YM0800X
Mental Health Counselor
Primary
39005093A
IN
Other
Enumeration date
06/23/2023
Last updated
12/05/2024
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