Provider Demographics
NPI:1972912210
Name:DONOVAN, MARY (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 NE 150TH PL
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4746
Mailing Address - Country:US
Mailing Address - Phone:206-499-7147
Mailing Address - Fax:
Practice Address - Street 1:8424 NE 150TH PL
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4746
Practice Address - Country:US
Practice Address - Phone:206-499-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60918849106H00000X
WAMG 60601202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist