Provider Demographics
NPI:1043315237
Name:MCDONALD, WENDY (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-3134
Mailing Address - Country:US
Mailing Address - Phone:979-846-8600
Mailing Address - Fax:866-214-0222
Practice Address - Street 1:207 SULPHUR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77801-3134
Practice Address - Country:US
Practice Address - Phone:979-846-8600
Practice Address - Fax:866-214-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0081JMOtherBLUE CROSS BLUE SHIELD
TX154728301Medicaid
TX154728301Medicaid
TXP72940Medicare UPIN