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Individual

SHELLY DONOGHUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3830 S CUSHMAN ST, FAIRBANKS, AK 99701-7530
(907) 455-1467
Mailing address
3830 S CUSHMAN ST, FAIRBANKS, AK 99701-7530
(907) 455-1467

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
MH0157
AK
Enumeration date
08/06/2007
Last updated
02/09/2012
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