Provider Demographics
NPI:1952616740
Name:MCDONALD, CONNIE SUE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:SUE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 131ST STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-6309
Mailing Address - Country:US
Mailing Address - Phone:253-592-8688
Mailing Address - Fax:
Practice Address - Street 1:3806 9TH ST SW STE F
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3687
Practice Address - Country:US
Practice Address - Phone:253-592-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60006062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist