MEDICARE: GARY WADE 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
1	101YP2500X	Professional Counselor	67694	TX

General Provider Information

NPI Number	:	1841537727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY WADE MCDONALD

Provider Business Mailing Address
First Line	:	1410 WOODLAND HILLS DR
Second Line	:
City	:	WHITEHOUSE
State	:	TX
Zip	:	75791-3718
Country	:	US
Telephone Number	:	903-570-9319
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 WOODLAND HILLS DR
Second Line	:
City	:	WHITEHOUSE
State	:	TX
Zip	:	75791-3718
Country	:	US
Telephone Number	:	903-570-9319
Fax Number	:

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

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	01/11/2013

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Directions to “ GARY WADE MCDONALD ” Practice Location

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