Provider Demographics
NPI:1316318918
Name:DONOVAN, SPENCER G (LMFT)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:G
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SOUTH STATE STREET OFFICE 8
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-2983
Mailing Address - Country:US
Mailing Address - Phone:435-823-2367
Mailing Address - Fax:
Practice Address - Street 1:255 SOUTH STATE STREET OFFICE 8
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-2983
Practice Address - Country:US
Practice Address - Phone:435-823-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9526166-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist