Provider Demographics
NPI:1790339638
Name:KIMBERLY MCDONALD-MARKUSON LCSW
Entity Type:Organization
Organization Name:KIMBERLY MCDONALD-MARKUSON LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MCDONALD-MARKUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-544-4055
Mailing Address - Street 1:P.O. BOX 5605
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806
Mailing Address - Country:US
Mailing Address - Phone:406-544-4055
Mailing Address - Fax:406-258-0150
Practice Address - Street 1:2825 STOCKYARD RD STE F4
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1508
Practice Address - Country:US
Practice Address - Phone:406-544-4055
Practice Address - Fax:406-258-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty