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General NPI Number Information
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NPI Number | 1528228087
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Entity Type | Individual
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Provider Name | LEE CHAIX MCDONOUGH LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 307 BOATNER RD STE 114 96TH MEDICAL GROUP - MENTAL HEALTH
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City | EGLIN AFB
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State | FL
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Zip | 32542-1302
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Country | US
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Telephone | 850-883-8273
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Fax |
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Provider Business Mailing Address
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Address Line | 52ND MEDICAL GROUP UNIT 3865
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City | APO
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State | AE
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Zip | 09126-3865
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9005
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License Number State | FL
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