MEDICARE: MR. MICHAEL R DONNELL PSY.D.

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	103TC0700X	Clinical Psychologist	PSY25096	CA
2	103TC0700X	Clinical Psychologist	36861	TX

General Provider Information

NPI Number	:	1851549737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL R DONNELL PSY.D.

Provider Business Mailing Address
First Line	:	1306B W 39TH 1/2 ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3906
Country	:	US
Telephone Number	:	415-533-6971
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306B W 39TH 1/2 ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3906
Country	:	US
Telephone Number	:	512-387-1172
Fax Number	:

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	03/16/2021

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