Provider Demographics
NPI:1285008045
Name:IVEY, JANA (LPC)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:IVEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 BELL ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-5033
Mailing Address - Country:US
Mailing Address - Phone:940-231-0885
Mailing Address - Fax:
Practice Address - Street 1:3131 BELL ST
Practice Address - Street 2:SUITE 105
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-5033
Practice Address - Country:US
Practice Address - Phone:940-231-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional