Healthcare Provider Details

I. General information

NPI: 1508879867
Provider Name (Legal Business Name): MICHAEL JAMES MCGRATH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 W 49TH ST SUITE 203
SIOUX FALLS SD
57106-4241
US

IV. Provider business mailing address

PO BOX 88834
SIOUX FALLS SD
57109-8834
US

V. Phone/Fax

Practice location:
  • Phone: 605-351-5987
  • Fax: 605-271-4495
Mailing address:
  • Phone: 605-351-5987
  • Fax: 605-271-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number211
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number211
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number211
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number211
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: