Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 239923 | KY |
NPI | 1003255696 |
---|---|
Provider Name | Tracy M Mcdonald |
First Address | Stearns, KY 42647 |
Second Address | Whitley City, KY 42653-4216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 11/05/2021 |