Provider Demographics
NPI:1497186308
Name:DONOVAN, LESLEY (LMFT)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DOVE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2432
Mailing Address - Country:US
Mailing Address - Phone:949-874-6629
Mailing Address - Fax:
Practice Address - Street 1:1600 DOVE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2432
Practice Address - Country:US
Practice Address - Phone:949-874-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM17781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist