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NPI Code Detail

MEDICARE: MR. RONALD GRANT MACDONALD JR. LPC, LISAC

MEDICARE: MR. RONALD GRANT MACDONALD JR. LPC, LISAC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLISAC-0989AZ
2101YP2500XProfessional CounselorLPC-10208AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871558361
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD GRANT MACDONALD JR. LPC, LISAC
Provider Business Mailing Address
First Line : PO BOX 790
Second Line :
City : PAGE
State : AZ
Zip : 86040-0790
Country : US
Telephone Number : 928-645-5113
Fax Number : 928-645-3254
Provider Business Practice Location Address
First Line : 463 S. LAKE POWELL BLVD
Second Line :
City : PAGE
State : AZ
Zip : 86040-0790
Country : US
Telephone Number : 928-645-5113
Fax Number : 928-645-3254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 05/14/2014

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