Provider Demographics
NPI:1447803960
Name:MCDONALD, BRENDA KAY (LMHC, LPC, RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LMHC, LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 CASCADE AVE UNIT 2309
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8586
Mailing Address - Country:US
Mailing Address - Phone:512-944-9795
Mailing Address - Fax:
Practice Address - Street 1:1248 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2630
Practice Address - Country:US
Practice Address - Phone:515-243-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63796101YP2500X
IA145030163W00000X
IA094889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse