Mcdonough, Tina Marie
Mcdonough, Tina Marie is an sole proprietor health care provider with primary practice located at 5878 Blackshire Path , Inver Grove Heights MN 55076-1621. She recently has 8 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Cognitive & Behavioral, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Health, Behavioral Health & Social Service Providers / Psychoanalysis, Behavioral Health & Social Service Providers / Group Psychotherapy, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Mcdonough, Tina Marie can be contacted via phone (612) 239-6262.Contact Information
Primary practice address
5878 Blackshire Path
Inver Grove Heights MN 55076-1621
Phone: (612) 239-6262
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | ||
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 103TA0400X | ||
| Behavioral Health & Social Service Providers / Cognitive & Behavioral | 103TB0200X | ||
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | ||
| Behavioral Health & Social Service Providers / Health | 103TH0004X | ||
| Behavioral Health & Social Service Providers / Psychoanalysis | 103TP0814X | ||
| Behavioral Health & Social Service Providers / Group Psychotherapy | 103TP2701X | ||
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 14534 | Minnesota |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X |
Profile Details
| NPI number | 1669815643 |
|---|---|
| LBN Legal business name | Mcdonough, Tina Marie |
| Credentials | L.I.C.S.W. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 9th, 2013 |
| Last updated | Nov 27th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669815643 | NPPES |
| Minnesota | MEDICAID | 1669815643 | |
| Minnesota | MEDICAID | VN000088953001 |
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