Healthcare Provider Details

I. General information

NPI: 1184791162
Provider Name (Legal Business Name): RONALD PAUL MCDONALD DMIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 NORTH SECOND STREET SAMARITAN COUNSELING CENTER DOWNTOWN
MEMPHIS TN
38103
US

IV. Provider business mailing address

35 SOUTH AUBURNDALE STREET
MEMPHIS TN
38104
US

V. Phone/Fax

Practice location:
  • Phone: 901-729-3900
  • Fax: 901-729-2737
Mailing address:
  • Phone: 901-729-3900
  • Fax: 901-729-2737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCPT000035
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: