Provider Demographics
NPI:1598190886
Name:DONAVAN, THOMAS E
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:DONAVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 IRVINE CENTER DR
Mailing Address - Street 2:STE 800
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:562-213-2337
Practice Address - Street 1:7700 IRVINE CENTER DR
Practice Address - Street 2:SUITE 800
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2923
Practice Address - Country:US
Practice Address - Phone:949-528-6300
Practice Address - Fax:562-213-2337
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28556103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical