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Organization
ROXANNE R DOMEK, PLLC
Active
Organization
ROXANNE R DOMEK, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROXANNE R DOMEK LPC (OWNER)
(480) 823-0360
Entity
Organization
Contact information
Practice address
3707 E SOUTHERN AVE STE 1066, MESA, AZ 85206-6206
(480) 823-0360
Mailing address
3707 E SOUTHERN AVE STE 1066, MESA, AZ 85206-6206
(480) 823-0360
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790819027
TYPE I NPI
ND
Enumeration date
01/20/2022
Last updated
01/20/2022
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