Provider Demographics
NPI:1679081137
Name:DONOVAN, LYNN SHIRLEY (RBT)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:SHIRLEY
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51-140 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KAAAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96730-9806
Mailing Address - Country:US
Mailing Address - Phone:808-237-8476
Mailing Address - Fax:
Practice Address - Street 1:2 AARONA PL STE 208
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2545
Practice Address - Country:US
Practice Address - Phone:808-797-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician