Provider Demographics
NPI:1235315243
Name:IVORY, CHERYL (MA,, LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:IVORY
Suffix:
Gender:F
Credentials:MA,, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BENMAR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060
Mailing Address - Country:US
Mailing Address - Phone:832-329-8500
Mailing Address - Fax:
Practice Address - Street 1:440 BENMAR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060
Practice Address - Country:US
Practice Address - Phone:832-329-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional