Provider Demographics
NPI:1003634189
Name:DONOVAN KNUTSON, SHAUNA (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:DONOVAN KNUTSON
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 LAURA CT
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7379
Mailing Address - Country:US
Mailing Address - Phone:619-277-0521
Mailing Address - Fax:
Practice Address - Street 1:213 SINUSO DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1533
Practice Address - Country:US
Practice Address - Phone:512-256-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health