Healthcare Provider Details

I. General information

NPI: 1780909820
Provider Name (Legal Business Name): GARY MACDONALD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 OSAGE ST STE 201
DENVER CO
80204-3436
US

IV. Provider business mailing address

1175 OSAGE ST STE 201
DENVER CO
80204-3436
US

V. Phone/Fax

Practice location:
  • Phone: 303-573-0839
  • Fax:
Mailing address:
  • Phone: 303-573-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3052
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3052
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3052
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0441416
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: