1336907484 NPI number — MRS. JACQUELYN RENEE MCDONALD DSW, AMFT, APCC

Table of content: MRS. JACQUELYN RENEE MCDONALD DSW, AMFT, APCC (NPI 1336907484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336907484 NPI number — MRS. JACQUELYN RENEE MCDONALD DSW, AMFT, APCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONALD
Provider First Name:
JACQUELYN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DSW, AMFT, APCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCDONALD
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DSW, AMFT, APCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336907484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92564-1134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-210-2142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1096 CALIMESA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALIMESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92320-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-372-0683
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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