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General NPI Number Information
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NPI Number | 1639426885
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Entity Type | Individual
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Provider Name | KRYSTENA L MACDONALD LMHC, MA, QMHP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 1001 W 10TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2859
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Country | US
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Telephone | 317-630-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 6104 LAKE FREEMAN DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-6913
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Country | US
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Telephone | 317-354-5520
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39002386A
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License Number State | IN
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