Individual ProviderTama Marie MckibbinCounselorBehavioral Health & Social Service ProvidersPractice Address1901 Cleveland Ave, #B, Santa Rosa Treatment Program, Santa Rosa, CA 95401(707) 576-0818PECOS EnrollmentBased on the most recent information from CMS, provider Tama Marie Mckibbin 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 2 days ago.Profile DetailsProvider ID1578735650Provider TypeIndividualFull NameMckibbin, Tama MarieGenderFemaleSole ProprietorNoEnumeration Date3/28/2008Last Updated8/19/2013Contact InformationPractice LocationPractice Address1901 Cleveland Ave, #B, Santa Rosa Treatment Program, Santa Rosa, CA 95401Phone(707) 576-0818Fax(707) 576-7845Mailing LocationMailing Address1901 Cleveland Ave, #B, Santa Rosa Treatment Program, Santa Rosa, CA 95401Phone(707) 576-0818Fax(707) 576-7845Provider TaxonomiesCodeDescriptionLicenseCode101YA0400XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseRI-M1301282236CaliforniaCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer