Individual
DOMONIC VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHP
Contact information
Practice address
2800 FREEWAY BLVD STE 204, MINNEAPOLIS, MN 55430-1751
(763) 412-1996
(763) 292-5653
Mailing address
2800 FREEWAY BLVD STE 204, MINNEAPOLIS, MN 55430-1751
(763) 412-1996
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0000000
MN
103TC1900X
Counseling Psychologist
0000000
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000
—
MN
Enumeration date
03/23/2021
Last updated
03/23/2021
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