Provider Demographics
NPI:1407626138
Name:FITCH, DONAVAN ALYSE (LPC)
Entity Type:Individual
Prefix:
First Name:DONAVAN
Middle Name:ALYSE
Last Name:FITCH
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 1:1871 SPANISH FORK WAY APT H102
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5631
Mailing Address - Country:US
Mailing Address - Phone:360-440-1379
Mailing Address - Fax:
Practice Address - Street 1:148 S COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0932
Practice Address - Country:US
Practice Address - Phone:208-683-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional