Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor |
NPI | 1346368040 |
---|---|
Provider Name | Mark Timothy Mcdonald |
First Address | Long Beach, CA 90802-5102 |
Second Address | Long Beach, CA 90802-2426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 28/06/2013 |