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NPI Code Detail

MEDICARE: DR. TRACY ANN MCDONOUGH PHD

MEDICARE: DR. TRACY ANN MCDONOUGH PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist5833OH

General Provider Information

NPI Number : 1780730960
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACY ANN MCDONOUGH PHD
Provider Business Mailing Address
First Line : 5701 DELHI RD
Second Line : DEPARTMENT OF BEHAVIORAL SCIENCE
City : CINCINNATI
State : OH
Zip : 45233-1669
Country : US
Telephone Number : 513-244-4939
Fax Number : 513-244-4941
Provider Business Practice Location Address
First Line : 5701 DELHI RD
Second Line : DEPARTMENT OF BEHAVIORAL SCIENCE
City : CINCINNATI
State : OH
Zip : 45233-1669
Country : US
Telephone Number : 513-244-4939
Fax Number : 513-244-4941
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2007
Last Update Date : 07/08/2007

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