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General NPI Number Information
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NPI Number | 1326608522
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Entity Type | Individual
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Provider Name | KYLE MACDONALD LPC-MHSP / LPC
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Gender | Male
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 9029 SIENNA RANCH ROAD
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City | MISSOURI CITY
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State | TX
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Zip | 77459
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Country | US
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Telephone | 281-399-4767
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 966
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City | FRESNO
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State | TX
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Zip | 77545-0966
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Country | US
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Telephone | 281-399-4767
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 4292
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License Number State | TN
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