Provider Demographics
NPI:1003178864
Name:DONOVAN, JANNA (LPCC)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8504 SAUREL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-3034
Mailing Address - Country:US
Mailing Address - Phone:502-689-7977
Mailing Address - Fax:
Practice Address - Street 1:1860 MELLWOOD AVE # 117
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1033
Practice Address - Country:US
Practice Address - Phone:502-689-7977
Practice Address - Fax:502-442-0020
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional