Healthcare Provider Details

I. General information

NPI: 1992212716
Provider Name (Legal Business Name): KELLY C DONOHUE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 E CHIPMUNK HOLW
RIMROCK AZ
86335-5736
US

IV. Provider business mailing address

4665 E CHIPMUNK HOLW
RIMROCK AZ
86335-5736
US

V. Phone/Fax

Practice location:
  • Phone: 508-887-5636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4897
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: