Provider Demographics
NPI:1295213171
Name:IVY PSYCHOTHERAPIES LLC
Entity Type:Organization
Organization Name:IVY PSYCHOTHERAPIES LLC
Other - Org Name:IVY PSYCHOTHERAPIES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVIM-TOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-474-7976
Mailing Address - Street 1:5783 HAYWAGON LN
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8584
Mailing Address - Country:US
Mailing Address - Phone:720-474-7976
Mailing Address - Fax:303-952-1506
Practice Address - Street 1:12900 STROH RANCH PL UNIT 125
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3490
Practice Address - Country:US
Practice Address - Phone:720-474-7976
Practice Address - Fax:303-952-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99236371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52720586Medicaid