Tama Marie McKibbin

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

RI-M1301282236 Issued in CA

Practice address

1901 Cleveland Ave, #B
Santa Rosa Treatment Program
Santa Rosa, CA 95401

Phone

(707) 576-0818

Fax

(707) 576-7845

NPI assigned

Mar 28, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376870400000",
    "number": "1578735650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CLEVELAND AVE, #B",
            "address_2": "SANTA ROSA TREATMENT PROGRAM",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95401",
            "telephone_number": "707-576-0818",
            "fax_number": "707-576-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 CLEVELAND AVE, #B",
            "address_2": "SANTA ROSA TREATMENT PROGRAM",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95401",
            "telephone_number": "707-576-0818",
            "fax_number": "707-576-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIBBIN",
        "first_name": "TAMA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-28",
        "last_updated": "2013-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "RI-M1301282236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Abelson McKenzie, LCSW
• Maureen McKenzie, MS RDN
• Rachel A McKenzie, MPT
• Victoria Ann McKenzie
• Lyn Maree McKeowen
• Cassidy Diane McKinney
• Dana K McKinney, NURSE PRACTITIONER
• Phoebe A McKinney, MFT TRAINEE
• Flavia R McKleroy
• Zachary McLennan

• Addiction (Substance Use Disorder) Counselor in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.