Provider Demographics
NPI:1003535006
Name:BYUN, IVY (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:IVY
Middle Name:
Last Name:BYUN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:
Other - Last Name:CHIANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6300 JOHN RYAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4122
Mailing Address - Country:US
Mailing Address - Phone:817-922-6000
Mailing Address - Fax:817-922-5955
Practice Address - Street 1:6300 JOHN RYAN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4122
Practice Address - Country:US
Practice Address - Phone:817-922-6000
Practice Address - Fax:817-922-5955
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional