Provider Demographics
NPI:1508343138
Name:MCDONALD, KALI BETH (LMFT-SUPERVISOR, LPC)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:BETH
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LMFT-SUPERVISOR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-9215
Mailing Address - Country:US
Mailing Address - Phone:817-221-8203
Mailing Address - Fax:
Practice Address - Street 1:621 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9215
Practice Address - Country:US
Practice Address - Phone:817-221-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77480101YP2500X
TX202669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional