Provider Demographics
NPI:1689374902
Name:MCDONALD, COLLEEN MARIE (MT-BC, RBT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:MCDONALD
Suffix:
Gender:
Credentials:MT-BC, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 PLAZA DR # 100A100B
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6954
Mailing Address - Country:US
Mailing Address - Phone:502-676-9030
Mailing Address - Fax:
Practice Address - Street 1:3306 PLAZA DR # 100A100B
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6954
Practice Address - Country:US
Practice Address - Phone:502-676-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst