Provider Demographics
NPI:1871291138
Name:MCDONELL, ROBERT MICHAEL (LMSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:MCDONELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 PLEASANT ST APT 301
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6101
Mailing Address - Country:US
Mailing Address - Phone:612-227-1511
Mailing Address - Fax:
Practice Address - Street 1:1450 NW 114TH ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7039
Practice Address - Country:US
Practice Address - Phone:515-553-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120966283Q00000X
IAT23015101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)