| Kelly Dominic, Imft Llc | |
| 
					10955 Clearport Rd Sw Amanda OH 43102-9612  | |
| (330) 730-9511 | |
| Not Available | 
| Full Name | Kelly Dominic, Imft Llc | 
|---|---|
| Speciality | Community/behavioral Health | 
| Location | 10955 Clearport Rd Sw, Amanda, Ohio | 
| Authorized Official Name and Position | Kelly M Dominic (MARRIAGE AND FAMILY THERAPIST OWNER) | 
| Authorized Official Contact | 3307309511 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Kelly Dominic, Imft Llc 10955 Clearport Rd Sw Amanda OH 43102-9612 Ph: (330) 730-9511  | Kelly Dominic, Imft Llc 10955 Clearport Rd Sw Amanda OH 43102-9612 Ph: (330) 730-9511  | 
| NPI Number | 1811698657 | 
|---|---|
| Provider Enumeration Date | 03/16/2023 | 
| Last Update Date | 03/16/2023 | 
| Certification Date | 03/16/2023 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1811698657 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |