Healthcare Provider Details

I. General information

NPI: 1649038282
Provider Name (Legal Business Name): ELIJAH MCDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S FREYA ST STE 206
SPOKANE WA
99202-4889
US

IV. Provider business mailing address

2110 S CANYON WOODS LN APT 101
SPOKANE WA
99224-5362
US

V. Phone/Fax

Practice location:
  • Phone: 509-389-7576
  • Fax:
Mailing address:
  • Phone: 913-777-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61518275
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: