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General NPI Number Information
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NPI Number | 1922117704
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Entity Type | Individual
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Provider Name | MARSHA L. MCDONOUGH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 808 W 34TH ST
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City | AUSTIN
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State | TX
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Zip | 78705-1102
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Country | US
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Telephone | 512-448-5070
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Fax | 512-451-0014
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Provider Business Mailing Address
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Address Line | 808 W 34TH ST
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City | AUSTIN
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State | TX
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Zip | 78705-1102
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Country | US
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Telephone | 512-448-5070
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Fax | 512-451-0014
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2-4833
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License Number State | TX
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