Provider Demographics
NPI:1437281540
Name:DONOVAN, ELIZABETH DAY (MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAY
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S ORCHARD ST STE 232
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1275
Mailing Address - Country:US
Mailing Address - Phone:907-529-6210
Mailing Address - Fax:
Practice Address - Street 1:410 S ORCHARD ST STE 232
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1275
Practice Address - Country:US
Practice Address - Phone:208-616-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ID8527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor