| 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 |