Provider Demographics
NPI:1467600452
Name:MCDONALD, JUSTIN DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DOUGLAS
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2394 34TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ARDOCH
Mailing Address - State:ND
Mailing Address - Zip Code:58261-9302
Mailing Address - Country:US
Mailing Address - Phone:701-777-4495
Mailing Address - Fax:701-777-6498
Practice Address - Street 1:WHITE EARTH MENTAL HEALTH
Practice Address - Street 2:26246 CRANE RD
Practice Address - City:WHITE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56591
Practice Address - Country:US
Practice Address - Phone:218-983-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical