Healthcare Provider Details

I. General information

NPI: 1225780935
Provider Name (Legal Business Name): ALLISON M DONOVAN MA, AMFT, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10116 JIBBOOM ST STE 8
TRUCKEE CA
96161-0101
US

IV. Provider business mailing address

PO BOX 2813
OLYMPIC VLY CA
96146-2813
US

V. Phone/Fax

Practice location:
  • Phone: 530-536-0634
  • Fax:
Mailing address:
  • Phone: 530-536-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT164592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: