Provider Demographics
NPI:1497198501
Name:DONOVAN, KEVIN P (PHD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:P
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 TUDOR DR
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5301
Mailing Address - Country:US
Mailing Address - Phone:913-682-8700
Mailing Address - Fax:
Practice Address - Street 1:1503 OHIO ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-2932
Practice Address - Country:US
Practice Address - Phone:888-362-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2117103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical