Andrew Donovan, LAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P2110003 Issued in AR

Practice address

1502 Mary Kay Blvd
Benton, AR 72015

Phone

(501) 315-3344

NPI assigned

Feb 27, 2017

Last updated

Jan 12, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Birch Tree Communities IncGroup PAC ID 5597749747, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Birch Tree Communities Inc

  dba Conway Branch

  • Community/Behavioral Health Agency
  • Conway, AR
  • NPI 1770733768
  Medicare reassignment Care Compare group NPD
• Birch Tree Communities, Inc

  dba Clinton Branch

  • Community/Behavioral Health Agency
  • Clinton, AR
  • NPI 1629228606
  NPD
• Birch Tree Communities, Inc

  dba Russellville Branch

  • Community/Behavioral Health Agency
  • Russellville, AR
  • NPI 1831349851
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1972043792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1589",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720181589",
            "telephone_number": "501-315-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 MARY KAY BLVD",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "72015",
            "telephone_number": "501-315-3344"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3715 N Business Dr Ste 104",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727035287",
            "country_code": "US",
            "telephone_number": "479-575-9471 x35012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONOVAN",
        "first_name": "ANDREW",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-27",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AR",
            "license": "A1810152",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P2110003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tywan Dobbins, RECOVERY ASSISTANT
• Kristina M Dodson Dupree, LCSW
• Pamela Diane Dodson, LPC
• Whitney Donahue
• Joseph Donnelly, CMP
• Carolyn Dotson, QBHP
• Adrienne Leigh Douglas, LCSW
• Susan Douglas, MHPP
• Dr Q Pain & Spine Clinic, PA (Arkansas spine and pain)
• Dream Big Pediatric Therapies

• Professional Counselor in Benton, AR
• Providers in Benton, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.