Mary Ann Dom, LPC is a
Counselor - Professional based in Leon Valley, Texas. Mary Ann Dom is licensed to practice in Texas (license number 12359) and her current practice location is
6502 Bandera Rd Ste 202, Leon Valley, Texas. She can be reached at her office (for appointments etc.) via phone at
(210) 488-0384.
NPI number for Mary Ann Dom is 1356507586 and her current mailing address is 8826 Thatch Dr, San Antonio, Texas. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1356507586.
Healthcare Provider's Profile
| Full Name | Mary Ann Dom |
|---|
| Gender | Female |
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| Speciality | Counselor - Professional |
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| Location | 6502 Bandera Rd Ste 202, Leon Valley, Texas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1356507586
- Provider Enumeration Date: 08/07/2008
- Last Update Date: 07/25/2019
Medical Identifiers
Medical identifiers for Mary Ann Dom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1356507586 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101Y00000X | Counselor | 12359 (Texas) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 12359 (Texas) | Secondary |
| 101YM0800X | Counselor - Mental Health | 12359 (Texas) | Secondary |
| 106H00000X | Marriage & Family Therapist | 12359 (Texas) | Secondary |
| 101YP2500X | Counselor - Professional | 12359 (Texas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mary Ann Dom is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mary Ann Dom, LPC
8826 Thatch Dr,
San Antonio, TX 78240-3714
Ph: (210) 488-0384 | Mary Ann Dom, LPC
6502 Bandera Rd Ste 202,
Leon Valley, TX 78238-1454
Ph: (210) 488-0384 |
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