1063645612 NPI number — HELLEN G. MCDONALD

Table of content: (NPI 1063645612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063645612 NPI number — HELLEN G. MCDONALD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HELLEN G. MCDONALD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HELLEN G. MCDONALD COUNSELING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063645612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 E MAIN ST
Provider Second Line Business Mailing Address:
#505
Provider Business Mailing Address City Name:
CHAMPAIGN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61820-3636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-378-8575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 E MAIN STREET
Provider Second Line Business Practice Location Address:
#505
Provider Business Practice Location Address City Name:
CHAMPAIGN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-378-8575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
HELLEN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PSYCHOTHERAPIST/OWNER
Authorized Official Telephone Number:
217-378-8575

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149009801 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 149.0098901 . This is a "ILLINOIS LICENCE TO PRACTICE AS LCSW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11589371 . This is a "CAQH #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1932219037 . This is a "TYPE I NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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