Individual
GARY LEE DONOVAN
Active
Individual
GARY LEE DONOVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
LP2839
MN
1041C0700X
Clinical Social Worker
Primary
LICSW 6209
MN
106H00000X
Marriage & Family Therapist
782
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25Y93DO
BCBS
MN
01
—
943101014248
PREFERRED 1
MN
Enumeration date
01/04/2007
Last updated
09/11/2025
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