Provider Demographics
NPI:1710739941
Name:DONOVAN, JARRID (MA, T-LLP)
Entity Type:Individual
Prefix:
First Name:JARRID
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:MA, T-LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32813 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1702
Mailing Address - Country:US
Mailing Address - Phone:248-702-4546
Mailing Address - Fax:
Practice Address - Street 1:32813 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1702
Practice Address - Country:US
Practice Address - Phone:248-702-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009698103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent