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NPI Code Detail

MEDICARE: MICHELLE MCDONALD

MEDICARE: MICHELLE MCDONALD
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 Counselor6401015215MI

General Provider Information

NPI Number : 1558837484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE MCDONALD
Provider Business Mailing Address
First Line : 6436 MILLSTREAM LOOP SE
Second Line :
City : CALEDONIA
State : MI
Zip : 49316-9179
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 250 MONROE AVE NW STE 400
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2293
Country : US
Telephone Number : 616-228-1286
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2018
Last Update Date : 10/18/2018

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Directions to “ MICHELLE MCDONALD ” Practice Location

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