Provider Demographics
NPI:1093354979
Name:DONOVAN, EMILY CLAIRE (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CLAIRE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 KESWICK CT
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5986
Mailing Address - Country:US
Mailing Address - Phone:618-310-6221
Mailing Address - Fax:
Practice Address - Street 1:3 THE PINES CT STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6081
Practice Address - Country:US
Practice Address - Phone:618-310-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-25
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty