=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720505886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCDONALD AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2017
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1360 NE 175TH STREET
-----------------------------------------------------
City | CITRA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32113-1075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-502-0376
-----------------------------------------------------
Fax | 352-502-0376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1075
-----------------------------------------------------
City | CITRA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32113-1075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-502-0376
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/OWNER
-----------------------------------------------------
Name | MRS. JUDY ANN MCDONALD
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 352-502-0376
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH7033
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------