Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PY01519 | MO |
NPI | 1114052909 |
---|---|
Provider Name | Dr. David Donovan |
First Address | Kansas City, MO 64114-5409 |
Second Address | Kansas City, MO 64114-5409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 11/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16878035 | BLUE CROSS BLUE SHIELD (01) | MO |