MEDICARE: G. LINDA MCDONALD BS, CAC III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	7512	CO

General Provider Information

NPI Number	:	1407132590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	G. LINDA MCDONALD BS, CAC III

Provider Business Mailing Address
First Line	:	3225 INDEPENDENCE RD
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9380
Country	:	US
Telephone Number	:	719-275-7650
Fax Number	:

Provider Business Practice Location Address
First Line	:	2981 BARRETT RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926-9529
Country	:	US
Telephone Number	:	719-275-7650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/20/2014

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