Provider Demographics
NPI:1619129038
Name:DONOGHUE, DENIS GERARD (MA, MDIV, LMHCA)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:GERARD
Last Name:DONOGHUE
Suffix:
Gender:M
Credentials:MA, MDIV, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17337 RESERVATION RD
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-8802
Mailing Address - Country:US
Mailing Address - Phone:360-466-7323
Mailing Address - Fax:360-466-1632
Practice Address - Street 1:17337 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-8802
Practice Address - Country:US
Practice Address - Phone:360-466-7323
Practice Address - Fax:360-466-1632
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60116136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992791Medicaid