Organization
KELLY DOMINIC, IMFT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY M DOMINIC LMFT (MARRIAGE AND FAMILY THERAPIST OWNER)
(330) 730-9511
Entity
Organization
Contact information
Practice address
10955 CLEARPORT RD SW, AMANDA, OH 43102-9612
(330) 730-9511
Mailing address
10955 CLEARPORT RD SW, AMANDA, OH 43102-9612
(330) 730-9511
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/16/2023
Last updated
03/16/2023
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