Provider Demographics
NPI:1528228087
Name:MCDONOUGH, LEE CHAIX (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:CHAIX
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52ND MEDICAL GROUP
Mailing Address - Street 2:UNIT 3865
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09126-3865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 BOATNER RD STE 114
Practice Address - Street 2:96TH MEDICAL GROUP - MENTAL HEALTH
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1302
Practice Address - Country:US
Practice Address - Phone:850-883-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL90051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical