Provider Demographics
NPI:1639472392
Name:MCDONALD, KATHERINE (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 SALLY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-2730
Mailing Address - Country:US
Mailing Address - Phone:863-605-2232
Mailing Address - Fax:
Practice Address - Street 1:140 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4124
Practice Address - Country:US
Practice Address - Phone:863-535-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101YM0800X
ARA1101010101YM0800X
ARP1203035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health