Provider Demographics
NPI:1255482865
Name:IVES, KATHY SOWERS
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:SOWERS
Last Name:IVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 FOXBORO DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3082
Mailing Address - Country:US
Mailing Address - Phone:469-879-3237
Mailing Address - Fax:
Practice Address - Street 1:3302 FOXBORO DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3082
Practice Address - Country:US
Practice Address - Phone:469-879-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health