Provider Demographics
NPI:1528347481
Name:MCDONALD, DAVID OWEN (PHD, LP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:OWEN
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2318
Mailing Address - Country:US
Mailing Address - Phone:325-201-7540
Mailing Address - Fax:620-245-5099
Practice Address - Street 1:1102 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2318
Practice Address - Country:US
Practice Address - Phone:620-245-5000
Practice Address - Fax:620-245-5099
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2405103TC0700X
KS2160103TC0700X
KS2245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200739980CMedicaid