Provider Demographics
NPI:1235978354
Name:MACDONALD, MATTHEW THOMAS
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 BELDING RD
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MI
Mailing Address - Zip Code:48865-9742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3170 BELDING RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MI
Practice Address - Zip Code:48865-9742
Practice Address - Country:US
Practice Address - Phone:616-780-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician