Healthcare Provider Details

I. General information

NPI: 1295964252
Provider Name (Legal Business Name): NORMA LEE DONOVAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LEE DONOVAN LMFT

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W MAIN ST
TUSTIN CA
92780-4320
US

IV. Provider business mailing address

228 W MAIN ST
TUSTIN CA
92780-4320
US

V. Phone/Fax

Practice location:
  • Phone: 714-566-5211
  • Fax: 714-566-5211
Mailing address:
  • Phone: 714-566-5211
  • Fax: 714-566-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39993
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMFC39993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: