Provider Demographics
NPI:1265572796
Name:MACDONALD, BARBARA LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LEE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SOUTH ADAMS ROAD
Mailing Address - Street 2:L-134
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6996
Mailing Address - Country:US
Mailing Address - Phone:248-802-1028
Mailing Address - Fax:248-618-7025
Practice Address - Street 1:725 SOUTH ADAMS ROAD
Practice Address - Street 2:L-134
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6996
Practice Address - Country:US
Practice Address - Phone:248-802-1028
Practice Address - Fax:248-618-1025
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002541103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
099128OtherMANAGED HEALTH NETWORK
11282443OtherCAQH
382434025OtherPPOM
382434025OtherTRI CARE
382434025OtherPRIVATE HEALTHCARE SYSTEM
MI680F334050OtherBLUE CROSS AND BLUE SHIEL
71779OtherCIGNA BEHAVIORAL HEALTH
MIM034769OtherCHAMPUS
120649OtherVALUE OPTIONS