Provider Demographics
NPI:1821212879
Name:DONOVAN, SCOTT EDWARD (LMFT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:EDWARD
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18888 US HIGHWAY 18 STE 106
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2315
Mailing Address - Country:US
Mailing Address - Phone:760-961-5370
Mailing Address - Fax:
Practice Address - Street 1:18888 OUTER HWY 18 STE 205
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2315
Practice Address - Country:US
Practice Address - Phone:760-961-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA101211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist