Provider Demographics
NPI:1508879867
Name:MCGRATH, MICHAEL JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MCGRATH
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:PO BOX 88834
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57109-8834
Mailing Address - Country:US
Mailing Address - Phone:605-351-5987
Mailing Address - Fax:605-271-4495
Practice Address - Street 1:3701 W 49TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4241
Practice Address - Country:US
Practice Address - Phone:605-351-5987
Practice Address - Fax:605-271-4495
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD211103G00000X, 103TC0700X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD22279OtherPSYCHOLOGIST/SIOUX VALLEY
SD4999824OtherPSYCHOLOGIST/BLUE CROSS/B
SD4999824OtherPSYCHOLOGIST/BLUE CROSS/B