Provider Demographics
NPI:1790124329
Name:MCDONALD, ADAM H B (MA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:H B
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:BUDDY
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:RAIL ROAD FLAT
Mailing Address - State:CA
Mailing Address - Zip Code:95248-0013
Mailing Address - Country:US
Mailing Address - Phone:209-754-9173
Mailing Address - Fax:209-754-9173
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2649
Practice Address - Country:US
Practice Address - Phone:209-754-9173
Practice Address - Fax:209-754-9173
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist