Provider Demographics
NPI:1013315290
Name:MCDONALD, BOBBIE (PSYD)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 E 18TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3069
Mailing Address - Country:US
Mailing Address - Phone:949-887-9616
Mailing Address - Fax:
Practice Address - Street 1:181 E 18TH ST
Practice Address - Street 2:STE B
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3069
Practice Address - Country:US
Practice Address - Phone:949-887-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26672103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist