Provider Demographics
NPI:1619284064
Name:MCDONALD-LOPEZ, MICHELLE CATHERINE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CATHERINE
Last Name:MCDONALD-LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CATHERINE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3857 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-236-7160
Mailing Address - Fax:360-438-1642
Practice Address - Street 1:3775 B MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-236-7160
Practice Address - Fax:360-438-1642
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60151153101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor