Provider Demographics
NPI:1669442372
Name:MCEACHRAN, DONALD JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JAMES
Last Name:MCEACHRAN
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 1:8500 THORNTREE DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1586
Mailing Address - Country:US
Mailing Address - Phone:734-671-5780
Mailing Address - Fax:
Practice Address - Street 1:1545 KINGSWAY CT
Practice Address - Street 2:201
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1931
Practice Address - Country:US
Practice Address - Phone:734-671-5640
Practice Address - Fax:734-692-9284
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005347103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI063569OtherVALUE OPTIONS
MI68OH246340OtherBLUE CROSS BLUE SHIELD
MI68OH246340OtherBLUE CROSS BLUE SHIELD