Healthcare Provider Details

I. General information

NPI: 1235978354
Provider Name (Legal Business Name): MATTHEW THOMAS MACDONALD LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 BELDING RD
ORLEANS MI
48865-9742
US

IV. Provider business mailing address

3170 BELDING RD
ORLEANS MI
48865-9742
US

V. Phone/Fax

Practice location:
  • Phone: 616-780-2522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025120
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: