# MARY ELLEN MOORE-DOMINGUEZ

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1992179659
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | 64939 | TX | Yes |

## Other

- **Enumeration date:** 11/18/2015
- **Last updated:** 11/18/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00R945 | MEDICARE | TX |
| 05 | — | 138708611 | — | TX |
| 05 | — | 138708613 | — | TX |