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NPI Code Detail

MEDICARE: MRS. ELAINE DONOVAN M.ED. L.P.E.

MEDICARE: MRS. ELAINE DONOVAN M.ED. L.P.E.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorPE0000011186TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1305-8435OTHERTNBCBS OF TN

General Provider Information

NPI Number : 1104902402
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELAINE DONOVAN M.ED. L.P.E.
Provider Business Mailing Address
First Line : 323 W WALNUT ST
Second Line : SUITE 219
City : JOHNSON CITY
State : TN
Zip : 37604-6760
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 323 W WALNUT ST
Second Line : SUITE 219
City : JOHNSON CITY
State : TN
Zip : 37604-6760
Country : US
Telephone Number : 423-434-9943
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2006
Last Update Date : 07/08/2007

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