Provider Demographics
NPI:1093303752
Name:LOHFF, IVY S (ASSOCIATE MFT)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:S
Last Name:LOHFF
Suffix:
Gender:F
Credentials:ASSOCIATE MFT
Other - Prefix:MRS
Other - First Name:IVY
Other - Middle Name:S
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ASSOCIATE MFT
Mailing Address - Street 1:2900 SAINT PAUL DR APT 112
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8521
Mailing Address - Country:US
Mailing Address - Phone:909-973-9741
Mailing Address - Fax:
Practice Address - Street 1:201 ALAMEDA DEL PRADO STE 201
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6698
Practice Address - Country:US
Practice Address - Phone:415-457-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA116424OtherBBS