MEDICARE: KATHERINE MCDONALD MA, LPC, LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0002010	CO
2	101YM0800X	Mental Health Counselor	NLC.0104689	CO
3	101YP2500X	Professional Counselor	LPC.0014444	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386044881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MCDONALD MA, LPC, LAC

Provider Business Mailing Address
First Line	:	3080 S KRAMERIA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7033
Country	:	US
Telephone Number	:	720-923-2122
Fax Number	:

Provider Business Practice Location Address
First Line	:	3080 S KRAMERIA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7033
Country	:	US
Telephone Number	:	720-923-2122
Fax Number	:

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

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	08/09/2023

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