Provider Demographics
NPI:1922117704
Name:MCDONOUGH, MARSHA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:L
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1102
Mailing Address - Country:US
Mailing Address - Phone:512-448-5070
Mailing Address - Fax:512-451-0014
Practice Address - Street 1:808 W 34TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1102
Practice Address - Country:US
Practice Address - Phone:512-448-5070
Practice Address - Fax:512-451-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical