Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ACC0006285 | CO |
NPI | 1538697131 |
---|---|
Provider Name | Timothy Mcdonald |
First Address | Littleton, CO 80121-8055 |
Second Address | Littleton, CO 80121-8055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2017 |
Last Update Date | 25/05/2017 |