Individual
DONAVAN ALYSE FITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
148 S COLE RD, BOISE, ID 83709-0932
(208) 683-8320
Mailing address
148 S COLE RD, BOISE, ID 83709-0932
(208) 683-8320
(208) 969-8380
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC-9595
ID
101YP2500X
Professional Counselor
Primary
LPC-9595
ID
Other
Enumeration date
01/03/2024
Last updated
08/06/2024
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