Provider Demographics
NPI:1356065668
Name:BEGAY, DONOVAN DALLAS
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:DALLAS
Last Name:BEGAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 N 19TH AVE STE 406-5
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3210
Mailing Address - Country:US
Mailing Address - Phone:928-399-1575
Mailing Address - Fax:
Practice Address - Street 1:5060 N 19TH AVE STE 406-5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3210
Practice Address - Country:US
Practice Address - Phone:928-399-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician