MEDICARE: BETH KAY MCDONALD LPC

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	LPC009499	GA
2	101YP2500X	Professional Counselor	LPCC3270	MN
3	101YM0800X	Mental Health Counselor	LPCC3270	MN

General Provider Information

NPI Number	:	1467982512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH KAY MCDONALD LPC

Provider Business Mailing Address
First Line	:	3410 FEDERAL DRIVE
Second Line	:	SUITE 101
City	:	EAGAN
State	:	MN
Zip	:	55122-1337
Country	:	US
Telephone Number	:	651-560-0050
Fax Number	:	651-925-0257

Provider Business Practice Location Address
First Line	:	3410 FEDERAL DRIVE
Second Line	:	SUITE 101
City	:	EAGAN
State	:	MN
Zip	:	55122-1337
Country	:	US
Telephone Number	:	651-560-0050
Fax Number	:	651-925-0257

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	07/11/2024

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