Individual ProviderTina Lee McdonoughMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address3440 Airway Dr Ste E, Santa Rosa, CA 95403-2065(707) 544-3299PECOS EnrollmentBased on the most recent information from CMS, provider Tina Lee Mcdonough does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1962549725Provider TypeIndividualFull NameMcdonough, Tina LeeCredentialMFT (MFC 50512)GenderFemaleSole ProprietorNoEnumeration Date1/31/2007Last Updated6/22/2013Contact InformationPractice LocationPractice Address3440 Airway Dr Ste E, Santa Rosa, CA 95403-2065Phone(707) 544-3299Fax(707) 544-6837Mailing LocationMailing Address3440 Airway Dr Ste E, Santa Rosa, CA 95403-2065Phone(707) 544-3299Fax(707) 544-6837Provider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseIMF51639California