Provider Demographics
NPI:1174874119
Name:MCDONALD, STEPHANIE N (BS, QMHP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:N
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:BS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S POLK ST APT 1322
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7580
Mailing Address - Country:US
Mailing Address - Phone:214-727-1704
Mailing Address - Fax:
Practice Address - Street 1:8625 KING GEORGE DR STE 111
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2240
Practice Address - Country:US
Practice Address - Phone:214-631-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker