Provider Demographics
NPI:1164248357
Name:MACDONALD, ELIZABETH BROWN (ACMHC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROWN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 N FORT CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1117
Mailing Address - Country:US
Mailing Address - Phone:801-850-7952
Mailing Address - Fax:
Practice Address - Street 1:1856 N FORT CANYON RD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1117
Practice Address - Country:US
Practice Address - Phone:801-850-7952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13404888-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health