MEDICARE: MR. MICHAEL MCDONALD MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1063490209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL MCDONALD MS

Provider Business Mailing Address
First Line	:	548 W ALEX BELL RD
Second Line	:	PRIVATE PRACTICE
City	:	CENTERVILLE FINANCE
State	:	OH
Zip	:	45459-3050
Country	:	US
Telephone Number	:	937-312-1611
Fax Number	:	937-312-1611

Provider Business Practice Location Address
First Line	:	548 W ALEX BELL RD
Second Line	:	PRIVATE PRACTICE
City	:	DAYTON
State	:	OH
Zip	:	45459-3050
Country	:	US
Telephone Number	:	937-312-1611
Fax Number	:	937-312-1611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	09/13/2022

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