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NPI Code Detail

MEDICARE: IVAN MACDONALD LCSWE

MEDICARE: IVAN MACDONALD LCSWE
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1245876689
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVAN MACDONALD LCSWE
Provider Business Mailing Address
First Line : 2100 STEPHENS AVE STE 105&106
Second Line :
City : MISSOULA
State : MT
Zip : 59801-6659
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 830 W CENTRAL AVE
Second Line :
City : MISSOULA
State : MT
Zip : 59801-7931
Country : US
Telephone Number : 406-829-9515
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2019
Last Update Date : 11/20/2019

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Directions to “ IVAN MACDONALD LCSWE” Practice Location

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