Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 13512 | AZ |
Y | 101YM0800X | Mental Health Counselor | 13512 | AZ |
N | 104100000X | Social Worker | 6128 | KS |
NPI | 1003030107 |
---|---|
Provider Name | Philip Lee Mcdonald |
First Address | Phoenix, AZ 85034-5340 |
Second Address | Phoenix, AZ 85034-5340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 26/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100098010B | (05) | KS |