Provider Demographics
NPI:1225224611
Name:MCDONOUGH, RENEE KRISTINE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:KRISTINE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7322
Mailing Address - Street 2:
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145-7322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2690 LAKE FOREST ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145
Practice Address - Country:US
Practice Address - Phone:530-581-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health