Provider Demographics
NPI:1225765357
Name:MCDONALD, MATTHEW (LACP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:LACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 UNIVERSITY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5618
Mailing Address - Country:US
Mailing Address - Phone:701-580-8788
Mailing Address - Fax:701-609-5231
Practice Address - Street 1:221 UNIVERSITY AVE STE 203
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5618
Practice Address - Country:US
Practice Address - Phone:701-580-8788
Practice Address - Fax:701-609-5231
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1219-7-15-22A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor