Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003365024 |
---|---|
Provider Name | Matthew Mcdonald |
First Address | Grain Valley, MO 64029-9043 |
Second Address | Grain Valley, MO 64029-9043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2016 |
Last Update Date | 03/10/2016 |