Healthcare Provider Details

I. General information

NPI: 1003227257
Provider Name (Legal Business Name): BRIAN M MCDONALD PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 N 3RD ST
PHOENIX AZ
85012-2331
US

IV. Provider business mailing address

3450 N 3RD ST
PHOENIX AZ
85012-2331
US

V. Phone/Fax

Practice location:
  • Phone: 602-957-2507
  • Fax: 602-265-8533
Mailing address:
  • Phone: 602-957-2507
  • Fax: 602-265-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4488
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: