Kenneth J McDonald, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSYC.00014021 Issued in CO

Practice address

9347 Sugarloaf Rd
Boulder, CO 80302-9221

Phone

(415) 264-9504

NPI assigned

Nov 10, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: kenneth.mcdonald@96713091579908.direct.elationemr.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542153600000",
    "number": "1366910028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9347 SUGARLOAF RD",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803029221",
            "telephone_number": "415-264-9504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9347 SUGARLOAF RD",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803029221",
            "telephone_number": "415-264-9504"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "356 East Elkhorn Ave.",
            "address_purpose": "LOCATION",
            "city": "Estes Park",
            "state": "CO",
            "postal_code": "80517",
            "country_code": "US",
            "telephone_number": "415-264-9504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-10",
        "last_updated": "2018-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSYC.00014021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joel E McCreary, DO
• Dirk McCuistion, L.M.T.
• Steven Emmett McCullough, MBA
• Susan Elizabeth McCullough, LCSW
• Megan McDermott, LMFT
• Nancy J McDonald, RN
• Taylor McDonald
• Maren McDonnell, MS, MFTC
• Ariel Fontaine McDowell
• Catie McDowell, LMFT

• Clinical Psychologist in Boulder, CO
• Providers in Boulder, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.