Provider Demographics
NPI:1497437867
Name:MCDONALD, ELLEN JO (TLMHC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:JO
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 226TH CT
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-8388
Mailing Address - Country:US
Mailing Address - Phone:515-210-2382
Mailing Address - Fax:
Practice Address - Street 1:12247 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8147
Practice Address - Country:US
Practice Address - Phone:515-212-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health