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General NPI Number Information
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NPI Number | 1770119091
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Entity Type | Individual
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Provider Name | EUGENE D MCDONALD LLC
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Gender | Male
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 6549 TOWN CENTER DR STE A
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City | CLARKSTON
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State | MI
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Zip | 48346-4824
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Country | US
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Telephone | 313-879-9960
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Fax |
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Provider Business Mailing Address
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Address Line | 6549 TOWN CENTER DR STE A
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City | CLARKSTON
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State | MI
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Zip | 48346-4824
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Country | US
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Telephone | 313-879-9960
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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 | 6451022506
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451022506
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License Number State | MI
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