Provider Demographics
NPI:1891702577
Name:DONOVAN, LAURA A (LMFT, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LMFT, LCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, LCSW
Mailing Address - Street 1:5322 DRY WELLS RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2236
Mailing Address - Country:US
Mailing Address - Phone:512-892-2978
Mailing Address - Fax:
Practice Address - Street 1:1823 FORTVIEW RD
Practice Address - Street 2:SUITE 106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7672
Practice Address - Country:US
Practice Address - Phone:512-731-7141
Practice Address - Fax:512-444-6124
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290951041C0700X
TX3062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027614OtherMHN
TX9093559OtherPHCS
TX0007300196OtherAETNA US HEALTHCARE
TX00709EOtherBLUE CROSS/BLUE SHIELD
TX10016916OtherAMERIGROUP
TX0007300196OtherAETNA US HEALTHCARE
TX9093559OtherPHCS