Provider Demographics
NPI:1205021219
Name:IVEY, JANIS KAYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:KAYE
Last Name:IVEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 VINCENT RD APT 902
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6270
Mailing Address - Country:US
Mailing Address - Phone:225-802-1361
Mailing Address - Fax:
Practice Address - Street 1:1024 E ASCENSION COMPLEX BLVD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4263
Practice Address - Country:US
Practice Address - Phone:225-644-4582
Practice Address - Fax:225-644-3635
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA37871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical