| Doctor Name: | MR. GREGORY MASON MACDONALD |
| NPI Number: | 1104077296 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 101YA0400X |
| Business Practice Address: | 12647 Olive Blvd Spectrum Healthcare Resources Creve Coeur, MO - 63141 |
| Business Phone Number: | 8003253982 |
| Business Fax Number: | 8776859866 |
| Mailing Address: | 12647 Olive Blvd, Spectrum Healthcare Resources CREVE COEUR |
| State: | MO |
| Postal Code: | 63141 |
| Phone Number: | 8003253982 |
| Fax Number: | 8776859866 |
| NPI Enumeration Date: | 10/07/2008 |
| NPI Last Update Date: | 10/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 101YA0400X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |